No Limits: A conversation with Dr. Shapiro

With this article, we introduce a new series of interviews, aptly (and intentionally) titled, “No Limits.”

In this column, we’ll spotlight osteopathic physicians who have ascended into areas and institutions where DOs are currently or have traditionally been the minority. We hope you will take pride in the accomplishments of our featured DOs and that medical students and recent graduates alike will see that talent, hard work and perseverance can make almost anything possible.

Our inaugural interview is with Fred Shapiro, DO, an associate professor of anesthesia at Harvard Medical School and the director of faculty development and promotion, research and medical student education at Massachusetts Eye and Ear. He has extensive research publication experience and is recognized nationally and internationally as an expert on patient safety in anesthesia and surgery performed outside the operating room.

Additional highlights from Dr. Shapiro’s CV include serving as president of the Massachusetts Society of Anesthesiologists and Suffolk District of the Massachusetts Medical Society (MMS). Recently, he created a Harvard Medical School elective which highlights the differences in the infrastructure, role of the anesthesiologist and determinants to ensure patient safety in the hospital, ambulatory and the office-based setting.

Dr. Shapiro is a co-founder of the Institute for Safety in Office-Based Surgery, an invited member of the Association of University Anesthesiologists, the SAMBA Board of Directors and the APSF Patient Safety Advisory Committee on Non-Operating Room Anesthesia. He has received numerous nominations at Harvard Medical School for excellence in mentoring.

In March 2023, he will receive the lifetime achievement Community Clinician of the Year award from the Suffolk District in recognition of his clinical and academic leadership in healthcare innovation, mentorship and education of the next generation.

I recently sat down (virtually) with Dr. Shapiro for a Q&A session.

I hardly know where to start, honestly. How about a little of your background?

Dr. Shapiro: I grew up in a suburb of Philadelphia, attended Temple University and the Kansas City College of Osteopathic Medicine (now Kansas City University College of Medicine and Biosciences) and completed my internship at Garden City Hospital in Michigan.

I worked at Roxborough Memorial Hospital in Philadelphia to research which specialty would be best suited for me. I applied, accepted and completed a residency in anesthesia at Boston University Medical Center (BUMC) and­­­, at that time, was the only DO resident in the program. After residency, I completed fellowships in pediatric anesthesia at Boston Children’s Hospital and a pain management ­­­­­fellowship at Mass General Hospital.

Did you always see yourself in academic medicine?

Dr. Shapiro: From a young age, I have always enjoyed learning and teaching. I was fortunate to have great role models and strong mentors who introduced me to academic medicine, which subsequently influenced the direction of my career. My mentors were smart, kind, humble and willing to take me under their wing. I worked hard, distinguished myself amongst my peers and received positive reinforcement, which led me to a clinical and academic career.

How did you get to Mass General and Harvard?

Dr. Shapiro: Both Boston Children’s Hospital and Mass General Hospital are Harvard Medical School teaching affiliates. Following residency at BUMC, I completed a year of Pediatric Anesthesia at Boston Children’s Hospital and an additional year working at The Franciscan “Special Needs’ Pediatric Hospital in Boston under the tutelage of Robert Moors Smith, MD, who was a Harvard Medical School professor, former chair of Children’s Hospital and author of “Smith’s Pediatric Anesthesia.” I was fortunate to work with a true visionary in the field of pediatric anesthesia.

Following my year in the early 90s at Franciscan Children’s, my osteopathic background led me to a fellowship in pain management at Mass General, where I worked diligently under the guidance and mentorship of some of the finest in the field: Don Todd, MD; Bucknam “Jack” McPeek, MD; and Dan Carr, MD. At that time, I was young and probably a bit naive about the “politics” of being a DO in an MD world. I simply followed my passion and with a strong work ethic, I successfully earned the respect of my colleagues. After running a very busy pain service of up to 125 patients per day, I was invited to remain on staff at Mass General following my fellowship.

Were there any other stops along the way to your current position?

Dr. Shapiro: Yes, I was asked to develop pain service offerings at Spaulding Rehab, Winchester Hospital and Malden Hospital (private practice hospitals in the Boston suburbs) while also working as a clinical anesthesiologist.

After a few years, I accepted a position as a clinical and academic attending anesthesiologist at Beth Israel Deaconess Medical Center in Boston, where I practiced until about two years ago when I returned to Massachusetts Eye and Ear, which is a Harvard Medical School teaching affiliate and part of the MGB Corporation.

You’ve risen to the rank of associate professor in anesthesiology at Harvard Medical School. However, this is just one of your responsibilities.

Dr. Shapiro: Yes, at Mass Eye and Ear, I serve as the director of faculty development and promotion, the director of medical student education and the director of Research/IRB delegate. These positions highlight my two missions: mentoring the next generation of physicians and improving patient safety in the ambulatory, outpatient and office-based anesthesia and surgical settings.

You mentioned the influence of working with some of the greats…

Dr. Shapiro: I was fortunate to be immersed in a culture of high achievement. The names you see on textbook covers and quintessential Harvard professors became my mentors and colleagues. I was recently asked if I’m interested in becoming a full professor at Harvard Medical School, often considered the pinnacle of academic achievement. Though honored, I’m content with where I am professionally.

At this stage of my life, I feel it’s truly about engaging the next generation. Yes, the thought of a kid from KCCOM having the potential to become a full professor at Harvard 40 years later is surreal. I owe my achievements to having the passion, focus, work ethic and strong mentors who guided me along my academic career path.

We both trained at fairly prestigious medical centers. I never felt being a DO was a hindrance, did you?

Dr. Shapiro: Not at all. To your point, we all have the same opportunities. One must distinguish oneself and focus; the successes and accomplishments will ultimately speak louder. I strongly believe that when an educator sees potential, it is natural to want to engage and guide a career path. I am fortunate that these people saw potential in me and mentors, years later, shared their appreciation of my achievements. That meant a great deal to me, especially coming from folks for whom I have the greatest respect. As my late mother said, “Hitch your wagon to a star!” I guess I did.

Tell us a little about this seminal work you’ve done and are doing in patient safety and office-based and ambulatory anesthesia.

Dr. Shapiro: For the past 30 years, there has been an increase in both number and complexity of patients and procedures being performed in the office-based setting with a lack of uniform regulations, resulting in some tragic high-profile deaths you may have seen covered in the media.

The American Society of Anesthesiologists (ASA) estimated that approximately 3 million office-based procedures were performed in 1995, which has grown exponentially to an estimated 24 million procedures in 2023. Recognizing this growth and complexity of patients and procedures, the changing landscape and the need to ensure patient safety, I created the first Harvard Medical School office-based anesthesia CME course and wrote “The Manual of Office-Based Anesthesia Procedures,” which led to a national OBA curriculum for the SAMBA. I wrote the seminal ASA CME article, “Office-Based Anesthesia: Safety and Outcomes,” and created a patient and practitioner safety checklist and emergency manual.

In 2009, I co-founded The Institute for Safety in Office-Based Surgery, an independent multi-disciplinary non-profit organization focused on promoting patient safety in office-based surgery through scholarships and patient/physician education.

I participated in the M.A. Board of Medicine taskforce to define qualifications for practitioners supervising office-based procedures and surgery, and recently revised the MMS office-based surgery guidelines. I also act as a resource to ASA governance regarding similar statewide national legislative changes.

This year, I introduced a Harvard Medical School elective course that will highlight the differences that determine patient safety and the role of the anesthesiologist in the hospital, ambulatory surgi-center and the office-based setting. Proper patient and procedure selection, personnel, equipment, drugs, resources and emergency preparedness are just a few examples.

Students will be exposed to adults, pediatrics, research and simulation technology depending upon their interests. The course will be available to any medical student (DO or MD) completing an ACGME-accredited program.

You said passions, plural. So, there’s more?

Dr. Shapiro: Absolutely. My work in ambulatory anesthesia and patient safety has drawn me into exciting research on brain technology, pain assessment, electronic based preanesthetic educational aids and AI application development to help clinicians, especially in remote locations, improve their decision-making process in the diagnosis and treatment of a deteriorating patient. In addition, we’re analyzing the effects of healthcare disparities (e.g., race, gender, ethnicity, language and location) in office-based anesthesia and surgical untoward events. This is very exciting, innovative and is raising awareness in the medical and technology communities.

Any parting thoughts for our readers, especially our students and graduate physicians in training?

Dr. Shapiro: To succeed, all one needs is to have passion, self-initiative and focus. There will always be challenges; one must be willing to accept rejection, naysayers and biases over new, different and innovative ideas. There were times over the years when I felt like a fish swimming against the tide. I maintained my passion, stayed focused and kept moving forward.

I’d like to share a triad that I learned from a beloved esteemed Harvard Medical School mentor (Daniel D. Federman, MD) on how to approach educating the next generation: Think before you speak, stick to the basics and always be kind.