Summary
Dr. Bernard Langer’s induction into the Canadian Medical Hall of Fame acknowledges his profound effect on medicine and surgery in Canada and an impact that has been truly international. In this brief biography, we highlight the major accomplishments that have made Dr. Langer a pre-eminent leader, innovator, teacher and exemplary surgeon.
Dr. Bernard Langer’s induction into the Canadian Medical Hall of Fame acknowledges his profound effect on medicine and surgery in Canada and an impact that has been truly international. In this brief biography, we highlight the major accomplishments that have made Dr. Langer a preeminent leader, innovator, teacher and exemplary surgeon.
“B.L.” or “Bernie,” as his friends and colleagues know him, was born in Toronto, Ont., in 1932. He received his medical degree from the University of Toronto in 1956, graduating with the Cody Gold Medal Award. Following an internship at the Toronto General Hospital (TGH), he completed his surgical training at the University of Toronto in 1962. During his residency, he married Ryna Manson and they began what was to become a family with 4 children: Jack, David, Pearl and Michael. Dr. Langer’s postresidency training, what would today be called a fellowship, was split between oncology with Dr. John Stehlin at M.D. Anderson Hospital in Houston, Tex., and experimental liver transplantation with Dr. Francis Moore at the Brigham Hospital in Boston, Mass.
Dr. Langer’s appointment to full attending staff at TGH in 1963 is recognized as a turning point in breaking down some of the antisemitic barriers in surgery that existed at the time. Although he practised the full range of general surgery, he developed an interest and expertise in the surgical management of portal hypertension and malignancies of the hepatobiliary system and pancreas — the genesis of the hepatico-pancreato-biliary (HPB) surgeon.
In 1972 Dr. Langer was appointed as the head of the Division of General Surgery at TGH, which was transformed under his leadership by his commitment to the emergence of subspecialties. His recruitment of Wayne Johnson and Paul Walker began the discipline of Vascular Surgery; Zane Cohen and Robin McLeod, Colorectal Surgery; Rudy Falk, Ulo Ambus and Lorne Rotstein, Surgical Oncology and Endocrine Surgery; and Bob Stone, Bryce Taylor and one of us (P.G.), HPB Surgery and Transplantation. This model became the standard for future recruitment and development within the Division of General Surgery at TGH and would serve as a model for other hospitals affiliated with the University of Toronto and across the country.
Dr. Langer is a “first generation” HPB and transplant surgeon. Along with the other pre-eminent HPB and transplant pioneers, like Henri Bismuth from France; John Terblanche from South Africa; and Dean Warren, Marshall Orloff and Tom Starzl from the United States, Dr. Langer’s advancement of the discipline of HPB surgery has resulted in it being recognized as a specific discipline within general surgery. During his career, he contributed to its understanding, and major advances occurred in the reduction of the morbidity and mortality of complex HPB procedures, including major liver resections and the Whipple pancreatico-duodenectomy. Dr. Langer started the liver transplant program in Toronto and performed Toronto’s first liver transplant in 1985. While pushing forward this specialty, he was also widely recognized as a “surgeons’ surgeon.” He was a gifted clinician and surgeon with very high standards and constantly challenged his colleagues to strive for excellence in patient care. Dr. Langer’s clinical nickname “The Hawk” came from his astute awareness of a patient’s clinical situation and his ability to manage it. Trainees and faculty members alike will recall his morbidity and mortality rounds, where he could incisively address the root cause of patient complications, even when these were outside his specific area of clinical expertise.
Dr. Langer’s impact on clinical care extended beyond his own patients. Through his leadership role in Cancer Care Ontario as a member of the Provincial Advisory Committee on Surgical Oncology, the Cancer Quality Council of Ontario and the Cancer Surgery Quality Committee, he championed standards for cancer care, including the Ontario Standards for HPB Surgery. This approach has translated across specialties and has served as a model for other provinces.
In 1982, Dr. Langer succeeded Dr. Donald R. Wilson as the R.S. McLaughlin Professor and chair of the Department of Surgery at the University of Toronto. He was the first non–surgeon-in-chief to do so, and his decade as chair was transformative for Toronto and highly influential across Canada and internationally. His most significant accomplishment is often identified as the creation of the Surgeon Scientist Program (SSP). He recognized Toronto’s reputation for excellence in clinical training, but saw the need for surgeons to engage in formalized research training as a requirement for the future academic success of individuals and the department. This highly successful program became the standard bearer for clinician–scientist training in faculties of medicine across the country. In 1994 the Royal College of Physicians and Surgeons of Canada established the Clinician Investigator Program, one largely modelled after the SSP. At the University of Toronto Department of Surgery, Dr. Langer’s “farm system” sustained and promoted academic excellence in surgery over the next 25 years and presumably will continue to do so into the future.
“As a physician leader, Bernie Langer was a true innovator, an extraordinarily gifted surgeon and a great teacher,” says Dr. David Naylor, dean of the University of Toronto Faculty of Medicine and former president of the University of Toronto. “The Surgeon Scientist Program he created has been widely emulated in other clinical departments across Canada and is a cornerstone of the department’s international reputation.”
Dr. Langer proposed and implemented a system of practice plans across the department that balanced individual division/hospital financial autonomy with the academic principle of income-sharing, with a view to fostering subspecialization and supporting academic initiatives. The challenges in doing so are almost unimaginable, but speak to Dr. Langer’s personal leadership and, in particular, his ability to rally individuals in support of the academic mission. Over the years, the practice plans have evolved, but their underlying raison d’etre, namely the support of activities to promote excellence in clinical care, research and education, has remained unchanged.
While most recall Dr. Langer as a tireless advocate for research in the department, his contributions to education have also had profound impact. As department chair, he established education as one of the streams for academic promotion. This has served to broadly engage a department filled with individuals who felt distanced from the research mission. He also recognized that improving the quality of education required that our faculty engage in advancing our understanding of surgical education. Today’s department is heavily populated with surgeons who have formal training in medical education and who are not only excellent teachers, but who also contribute through scholarship. Dr. Langer is also recognized for his personal contributions to education through his creation of the fellowship in liver surgery, which grew from 1 fellow in 1982 to 3 fellows in transplant and HPB surgery in 1989 to 7 Fellows in 2 separate but integrated fellowships in HPB surgical oncology (accredited by America’s Hepato-Pancreato-Biliary Association and the Fellowship Council) and in abdominal organ transplantation (accredited by the American Society of Transplant Surgeons). At a reunion of former fellows in 2013, Dr. Langer was recognized:
Amongst his notable accomplishments, Dr. Langer has been recognized by the [University Health Network] for “making global impact.” His growing legacy of over 65 fellows practising HPB and transplant surgery throughout the world is tangible evidence of Dr. Langer’s truly remarkable global impact. We thank you, B.L., for your vision in establishing the fellowship, your high standards and clinical excellence in HPB and transplant surgery that is carried on in your fellows, and your mentorship that extends beyond clinical surgery.”
Dr. Langer has had significant influence outside of Toronto. He was president of the Canadian Association of General Surgeons in 1988–89 and President of the Society for Surgery of the Alimentary Tract in 1993–94 and subsequently the chair of their Board of Trustees; in 1999 he became the first vice president of the American Surgical Association. Through his engagement with the Royal College of Physicians and Surgeons of Canada, Dr. Langer has contributed to Canadian medicine by advancing many of his priorities. He was president and chair of the Royal College Council and Executive Committee from 2000 to 2002, and he created the Canadian Patient Safety Institute.
Dr. Langer’s contributions and influence have been recognized through many honours, including the creation of the University of Toronto Department of Surgery Langer Surgeon Scientist Award, the Bernard Langer Annual Lecture in Health Sciences at the University of Toronto, the Bernard and Ryna Langer Chair in General Surgery at the University of Toronto, and the Langer Lecture of the Canadian Association of General Surgeons Annual Meeting held at the Canadian Surgery Forum. He has received honorary fellowships from the Royal Australasian College of Physicians, the Colleges of Medicine of South Africa, the American College of Physicians and the Academy of Medicine of Singapore as well as an honorary doctorate from Queen’s University
In 2002 Dr. Langer was appointed Officer of the Order of Canada. His extraordinary accomplishments are founded on a number of outstanding personal qualities. He always cared deeply for his patients, understanding not only their physical problems, but also personal or emotional issues that might be impacting their disease. Excellent technical ability was only one aspect of achieving the best outcome for his patients. The high degree of respect in the eyes of his surgical peers also facilitated his ability to influence his colleagues. Dr. Langer also exhibited exceptional leadership abilities. Teamwork was paramount. He engaged individuals with similar and disparate expertise to tackle tough problems. He promoted faculty, particularly those more junior, by giving them opportunities to participate and to develop their own leadership skills. He surrounded himself with excellent colleagues and listened carefully to their advice, but always remained true to his ideals. He was a tough negotiator but always sought the “win–win” outcome, even before this saying became popular. Finally, in an era when attention to personal life and family were considered a weakness, Dr. Langer always recognized the importance of the support of his wife Ryna and his family.
Bernard Langer’s induction into the Canadian Medical Hall of Fame is highly appropriate. The Hall of Fame is “dedicated to celebrating the accomplishments of medical heroes.” Dr. Langer is that, and more. He has been quoted as saying “If you don’t stand tall enough, you can’t see far enough.” Dr. Langer stood very tall and took us very far. He is a visionary, always looking beyond the present into the future.
Footnotes
Competing interests: None declared.
Contributors: Both authors contributed substantially to the conception, writing and revision of this commentary and approved the final version for publication.
- Accepted February 26, 2015.