Pursuit of Excellence

If life were a competitive sport, Toni Ganzel would be a gold-medal Olympian.

Few people manage to wring as much achievement from a 24-hour day as Ganzel, associate dean of student affairs in the University of Louisville School of Medicine.

That's because in addition to serving as dean of students, Ganzel is a highly regarded ear, nose and throat surgeon, a respected School of Medicine faculty member, a valued participant in numerous community service projects and a driving force behind a nationwide campaign to standardize preparatory training for surgery interns.

In between, Ganzel manages to dedicate a substantial amount of time to her husband, Brian, a UofL heart surgeon, and their two young daughters, Natalie and Paige. No matter what she does, Ganzel is driven to excel.

Take something as innocuous as recreation.

An avid mountain biker, Ganzel currently is training for a 120-mile "triple bypass" event in which competitors climb and descend 12,000 vertical feet of Colorado mountain passes on their way to the finish line.

But Ganzel isn't interested in competition for the sake of hollow bragging rights. She's playing for different stakes, whether it's simple self-improvement or something far more altruistic.

"It's all about making the world a better place," Ganzel says. "As a wife and mother, I get a tremendous amount of satisfaction from knowing that I'm making a difference in the lives of my family. As a surgeon and physician, I know I'm making a difference in the lives of my patients. And as dean of students, I know I can make a difference in the lives of our students.

"Students are the heart and soul of what we do here, and having the chance to influence those future physicians is a very exciting opportunity."

One future doctor, second-year medical student Bethanie Hammond, says Ganzel's quest for excellence is truly inspiring.

"Dr. Ganzel has a genuine interest in the student body and in making the school the best that it can be," says Hammond, president of the medical school's student senate. "Her ambition is driven by a desire to make things better, and it's reflected in everything we see her do. I think that's contagious. It trickles down to every student here."

Jeffrey Bumpous, M.D., agrees.

"One of the things that's impressive about Toni is that she's not concerned about power or position," says Bumpous, who became director of the university's Division of Otolaryngology when Ganzel stepped down in 1998 to pursue an M.B.A.

"She's more concerned with what needs to be fixed. And when Toni becomes involved in a process, a lot of things start to happen. She's very optimistic, she's very progressive and she puts a tremendous amount of energy into any project. Others pick up on that."

Equally impressive is Ganzel's ability to balance professional and personal obligations, says Laura Schweitzer, Ph.D., vice dean for faculty and administrative affairs.

"Besides being an excellent surgeon and dean of students, Toni has a very strong family commitment, which makes her a wonderful role model in every way," Schweitzer says.

"She's able to show students that they can go into demanding specialties without giving up their families or personal lives, and that gives them perspective -- it helps students see that there is a way to maintain balance in their lives.

"Our physicians must be aware of the human side of life," Schweitzer says. "It helps them become better adjusted in their personal lives and, therefore, better able to help their patients."

This example sends a "tremendous message" to students, Bumpous notes.

"If a physician's only focus is medicine and science, he loses some of his humanity. Toni is a good reminder that you must have both."

As good as you could be

Born in Roswell, N.M., Ganzel was reared in a military household with a strong focus on bedrock values like personal integrity and commitment to excellence.

"Our philosophy was to be honest and kind and strong -- to be as good as you could be," Ganzel recalls. "That's the sort of outlook that gets you through the tough times. It's good advice for kindergarten or medical school or even a career as a physician."

Ganzel's father, a pilot in the U.S. Air Force, took the family with him as he deployed for numerous assignments around the world, including billets in England, California, Louisiana and Montana.

By the time Ganzel was in high school, however, the family had settled down for an extended tour of duty at Offutt Air Force Base in Omaha, Neb.

Many children find such multiple relocations difficult, but they seemed to foster a resilience in Ganzel.

"I loved moving around," she recalls. "It didn't bother me one bit. Even now, I'll bloom wherever I'm planted. Just put me where you want me."

In 1971, Ganzel was planted a hour's drive from Offutt -- as a freshman at the University of Nebraska. There, she pursued her interest in science with the goal of becoming a high school science teacher.

"It never occurred to me then to become a doctor because women just didn't do that," she recalls.

But as her studies progressed, Ganzel began to realize that high school science teachers rarely do more than convey the most fundamental concepts to their students.

Ganzel, however, wanted to plumb the depths of science. She considered applying to Ph.D. programs and becoming a researcher, but that would mean many hours of solitary discovery behind a microscope.

Her outgoing personality needed human interaction, and her intellect sought the rigors of science. The now-obvious choice was medicine, and so Ganzel took the MCAT on a whim.

Her scores were so promising that she decided to investigate the field further by shadowing an Omaha physician. Those experiences changed her life.

"I realized what an influence this doctor had on his patients and the community," Ganzel recalls. "He was a wonderful family physician, and I wanted to make that kind of difference too."

Ganzel was accepted into medical school at the University of Nebraska in 1975 and hasn't looked back.

Following a residency in otolaryngology -- a field she entered because of her fascination with the senses of taste, smell and hearing -- Ganzel spent a year at Omaha's Boys Town Institute, which specializes in treating communications disorders in children.

Her first -- and so far only -- professional stop outside the Cornhusker state was UofL, which she joined as an assistant professor of surgery in 1983.

The decision to move here was not a difficult one, given the fact that Ganzel's husband, whom she married the previous year, was already being offered a cardiac surgery fellowship at UofL.

"We kind of came down as a team," Ganzel recalls, "with the idea of going back to Nebraska when Brian finished his fellowship. Then, in the third year of Brian's fellowship, he was offered a full-time position in Dr. Laman Gray's group here. In the meantime, I'd helped build the university's pediatric otolaryngology program and just loved it at UofL. So we've been here ever since."

Ganzel quickly rose up the academic ranks, becoming a full professor of otolaryngology in 1998 and director of the Division of Otolaryngology by 1993.

In that capacity, she was instrumentalin helping strengthen the program by recruiting a physician-scientist and several M.D.s to fill the voids in specialty areas.

While her tenure as division director was productive, Ganzel felt the need for even more administrative responsibility -- something, perhaps, that would tap her desire to work closely with students.

"I also had this compulsion to learn more about business," Ganzel recalls. "I felt that physicians really needed to be bilingual -- to speak both business and medicine -- if we were to play any role in shaping a better health care system."

In 1998 Ganzel stepped down as divisional director and enrolled in a grueling 2 1/2-year M.B.A course.

"It was a long, long road," Ganzel recalls. "I was probably getting four hours' sleep a night, because the course work required 25 hours a week on top of my duties as a teacher and physician."

But the pain was worth it, she says.

"It was fabulous training. It helped me think in a systematic way, to see the bigger picture and to clearly focus on what needs to be done to improve any given situation."

Focus on leadership

Ganzel took the lessons she learned from her M.B.A. work and applied them to the School of Medicine.

When the dean of students' job opened up, she developed a comprehensive agenda for improving the medical student experience and presented it as part of her interview with the school's search committee.

"It was a national search, and all the candidates were of extremely high caliber," says Schweitzer, who chaired the committee. "But Toni really came across as the strongest candidate because she had very good ideas about what she could do in that office."

Among them was the creation of programs to hone leadership skills and professionalism among medical students.

Ganzel now sponsors student retreats each semester that focus on topics like goal setting, strategy development, team building, conflict resolution and quality improvement.

"One of the real passions I have is student leadership," Ganzel says. "I think if physicians understood leadership better, they could help shape a better system."

Our society has, for example, decided to limit the resources it dedicates to health care, Ganzel says. Doctors therefore need to take the lead in patient care to be good stewards of those limited resources, rather than allowing purely financial considerations to dictate treatment.

"That may mean looking for ways to make the system more patient-centered, or looking for ways to make processes more efficient and safer for patients," she says.

"But these are real leadership issues. There needs to be a critical mass of physicians who are willing to look at the big picture, to understand that, yes, medicine is a healing art -- it's a humanitarian profession.

"But health care also is $3 trillion industry in the society we serve, and we have to practice the healing art within the context of that society.

"So we must have a broader view of things. And that means understanding about business and leadership. Sometimes there are inherent conflicts of interest between medicine and business, and I'm convinced that physicians are the only ones who can really reconcile that cultural clash. You've got to care and crunch the numbers.

"Physicians have that sense of the all-importance of the patient. Business people have a harder time making truly patient-centered decisions."

Bumpous praises Ganzel's focus on leadership, calling it "critically important."

"A lot of things are now driving medical care that are not in the patient's best interests," Bumpous says. "Part of a physician's role, now more than ever, is to be an advocate for our patients, and we can't be more effective advocates without developing our leadership skills."

Another key part of Ganzel's agenda is her professionalism initiative.

"We need students to understand that professionalism doesn't start the moment they walk in the room with a patient," she says. " It starts the day they come to medical school. We expect altruism, and we expect respect for others. We expect honesty and integrity.

"In the wake of business scandals like Enron, this is an answer to a need from the public, from our patients and from our system. But more importantly, it's the right thing to do."

Medical students like William Nunley applaud Ganzel's convictions.

Nunley, who took a one-year leave of absence from UofL to accept a national post with the American Medical Student Association, says Ganzel's values "work to empower medical students."

"She believes that future physicians have a tremendous responsibility to redefine the field of medicine, whether that's in academia or private practice," he says.

"Medicine is changing. I think it has to change, and Dr. Ganzel is part of the solution."