General Surgery Residency History

The Concise History of 

MercyOne General Surgery Residency

Written evidence places the origins of our program to 1921 when Dr. J.P. Schwartz started training under Dr. Simeon L. Taylor in the now-closed Des Moines General Hospital1. Similar to some other American departments of surgery, its roots trace to Dr. William S. Halsted of Johns Hopkins University Department of Surgery in Baltimore, Maryland, as Dr. Taylor trained there. Des Moines General Hospital transferred its residency to Mercy Medical Center², Des Moines, IA in July 2001, where surgical training continues to this day. The program was eventually transitioned from the oldest osteopathic surgical training program to the Next Accreditation System under the ACGME rules in 2013 and then again in 2018.

Dr. Taylor’s graduate education included 2½ years at the Still College of Osteopathy and three years of medicine at the University of Nebraska, thus earning both D.O. and MD titles. He then moved to Maryland as an intern at St. Agnes’ hospital in Baltimore. He continued surgical residency at the John Hopkins University under the direction of Dr. William Halsted (Johns Hopkins Department of Surgery 1886-1992³) until 1909, when he returned to Des Moines, IA, and started his practice⁴⁵.

Simeon Lafayette Taylor, AB, DO, MD⁶ provided postgraduate surgical training in the Des Moines area independently of the local Still College of Osteopathy⁷. Before becoming a surgeon, Dr. Taylor was a preacher and later became the President of Still College. Based on historical documents, Dr. Taylor’s “very appearance commanded respect.” At the same time, his diligent work culminated in his Taylor clinic drawing patients from surrounding states, even in competition with the growing Mayo Clinic of the Mayo brothers in Rochester, MN. Taylor Clinic survived his departure from practice, and Dr. J.P. Schwartz continued the clinic together with Dr. Howard Graney. The exact date of the clinic transformation remains unclear. Dr. Norman Rose recalled “Taylor Clinic,” but it wasn’t in existence by the time of his surgical practice in the 1960s. 

The first documented trainee of this program is John Peter Schwartz, D.O. (aka “J.P.”, “Pinkie”), who entered as an intern in Des Moines General Hospital in 1921 and became “assistant” surgeon the next year to Dr. S. L. Taylor. Dr. J.P. Schwartz himself would become a pre-eminent general surgeon, the President of Still College, and program director⁸ (“trainer” as it was described at that time) of the Des Moines general program until Norman Rose, D.O., took over in 1962. Dr. Rose directed the program until 1992, when he moved to Florida, where he continues teaching medical education and is associated with Larkin Memorial Hospital, Larkin, FL. 

The second identifiable surgical trainee is Howard Graney, D.O., who graduated from Still College of Osteopathy in 1933. He trained under J.P. Schwartz from 1935 through 1940 and joined the staff of Des Moines General Hospital afterward. Dr. Graney was never a program director, yet he was a nationally recognized surgeon remembered as a “gentleman”⁹ who shaped this program with quality and the historical breadth of skills our trainees attained. To this day, Des Moines University maintains the Howard Graney Scholarship to promote surgical education.

Norman Rose, D.O., FACOS, FICS trained under Drs. J.P. Schwartz and Graney remained at the Des Moines General Hospital after completing the training and took over program leadership in the 1960s. The residency continued to take one new (occasionally 2) residents per year. Under the American Osteopathic Association (AOA) rules, training required a one-year rotating internship followed by three years of surgical training. Subsequent entry into practice with board certification required the aspiring fellow to perform cases in the presence of an independent board-certified surgeon, thus further ensuring quality with “direct observation”, an approach adopted by the ACGME10 much later.  

Des Moines General Hospital was a highly successful osteopathic hospital, ultimately reaching a zenith of 250 beds, 12 operating rooms, a 12-bed ICU by the 1990s, and was highly sought-after by the Des Moines metropolitan population. Several trainees (William Stanley, D.O. & Daniel Waters, D.O.) completed cardiothoracic surgery fellowships at the famed Cleveland Clinic¹¹. By the 2000s, there was a burgeoning effort to unify the U.S. medical environment, aimed at unifying osteopathic and allopathic credentials already in place. The process aimed to merge residencies and fellowship was begun. Many osteopathic surgeons obtained staff credentials in other Des Moines hospitals regarded as allopathic institutions. The most recognizable of these was Kendall Reed, D.O.¹². This cross-over combined with the State of Iowa’s need for the Des Moines General Hospital’s grounds as the site for its new administrative building led to dialogue about the hospital’s eventual closure. Mercy Des Moines purchased the Des Moines General Hospital for temporary management and gradually transferred assets from the General Hospital to its main hospital at 6th Avenue. Mercy subsequently closed the hospital and sold its acreage to the State of Iowa as planned¹³. The State of Iowa consequently later gave the Certificate of Need that allowed the construction of MercyOne West Lakes hospital in Clive, IA in 2009, as a response to the westward expansion of the Des Moines metro area into heavily populated suburbs such as West Des Moines and Waukee.

The General Surgery residency program transfer occurred in July 2001 under the leadership of Kendall Reed, D.O., and the program grew in the early 2000s to four residents per year. Dr. Reed led the program’s growth after the transfer, and the Mercy Medical Center at that time had only the surgery and family practice residencies. The surgery residency was so integrated with the clinical practice led by the dominant surgical group that residents actually had their mailboxes in the Surgical Affiliates prive office around 2008. Administrative duties of Dr. Reed increased after he became a Dean of the College of Osteopathic Medicine of Des Moines University, and the program was for a short time led by Bradley Smith, D.O. (2005-2006). Charles D. Goldman, M.D., took over the program in 2007 and led it until 2016. During that time, the program maintained accreditation status by the AOA and achieved its initial ACGME accreditation in 2013. Thus, this program was the first institution nationally that held both available accreditation statuses, even before the Next Accreditation System rules of 2015 were published.

Surgeon staffing challenges and increasing clinical volume in both the downtown 600+ bed MercyOne Medical Center and nearly 100-bed MercyOne West Lakes Hospital led to amplified pressure on both staff surgeons and resident physicians culminating in the temporary loss of the ACGME accreditation in 2016-17¹⁴ (the AOA approval was maintained). The program had 21 residents at that time, of which five graduated, 12 transferred to other programs with the impressive help of MercyOne administration15, one chose not to pursue training further at that time, and three residents stayed on under the AOA approval despite having the opportunity to go on to other ACGME-accredited programs¹⁶.

Jan Franko, M.D., Ph.D., assumed program leadership in November 2016 under arduous conditions. We addressed the program’s options and went on to the rebuilding phase by consensus. We have recruited four interns via match starting in July 2017¹⁷. With three seniors from the prior program (two PGY5 and one PGY4), the program’s cohort was seven residents. Strict adherence to the ACGME work hour rules resulted in many nights and weekend days. The hospital was without resident physicians’ coverage and thus relied on attending physicians only. In light of that limitation, we redesigned the resident’s education and clinical work structure.

Jan Franko, MD

Residency resumed 24/7 in-house call in July 2019, and six new faculty surgeons joined the Staff (Dr. Tee, Dr. Losh, Dr. Neitzel, Dr. Patterson, Dr. Ismail, and Dr. Brambtatt). The redesigned program achieved its ACGME initial accreditation in January 2019. In January 2022, the ACGME conferred continued accreditation.

Acknowledgement

This program’s history review was initiated after obtaining the ACGME accreditation in January 2019. I am in debt to many individuals who helped with data collection and by personal account. Many thanks to Norman Rose, D.O.; Kendall Reed, D.O.; Daniel Waters, D.O.; Charles Goldman, MD; David Kermode, D.O.; Dennis Whitmer, D.O.; Mark Smolik, MD; Mrs. Key Grigsby (DMU Archivist & Special Collection librarian); Mrs. Andrea Wilcox, MHS (Program Coordinator 2016-2020). 

Jan Franko, MD, PhD, FACS, FSSO, DABS

 May 2019, Updated February 2022