Mentor Spotlight: Dr. Alan W. Flake
About the Mentor
Dr. Alan W. Flake is a world-renowned pediatric and fetal surgeon whose pioneering work has reshaped the field of fetal diagnosis and therapy. He is an attending surgeon in the Division of Pediatric General, Thoracic, and Fetal Surgery at the Children’s Hospital of Philadelphia (CHOP), where he holds the Ruth M. and Tristram C. Colket, Jr. Endowed Chair in Pediatric Surgery. As a Professor of Surgery and Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania, Dr. Flake is internationally recognized for advancing fetal intervention, neonatal surgery, regenerative medicine, and innovative treatments for life-threatening congenital disorders. His early experimental work in fetal lambs helped establish foundational principles in fetal surgery and continues to inform modern techniques used around the world.
For more than two decades, Dr. Flake has directed a highly influential National Institutes of Health funded research laboratory dedicated to developing prenatal therapies for genetic and anatomic abnormalities. Under his leadership, the Center for Fetal Research has achieved landmark breakthroughs, including in utero stem cell and gene therapy approaches and a physiologic support system for extremely premature infants with the potential to transform the treatment of prematurity. He has authored more than 350 peer-reviewed publications and over 100 review articles and book chapters, and he has served on numerous NIH study sections and editorial boards spanning hematology, stem cell biology, and fetal therapy. Dr. Flake is also widely respected for his mentorship of the next generation of surgeons, including the many women whom he has supported, trained, and championed as they rise to leadership roles across pediatric and fetal surgery.
Outside of the laboratory and operating room, Dr. Flake is an accomplished fly-fisherman who has traveled the globe in pursuit of remarkable waters. He has fished the San Juan River in New Mexico, the Teton River in Idaho, and the storied Jurassic Lake in Argentina, among many other destinations. He also enjoys the companionship of his beloved German Shepherd, Wolf. Whether advancing the future of fetal therapy or finding clarity on the water, Dr. Flake embodies excellence, curiosity, and an unwavering commitment to improving the lives of children and families everywhere.
Interview
Q: What inspired you to pursue a career in surgery, and how did you find your specific area of interest?
A: I'm not sure whether I found surgery or surgery found me. It’s the same process everyone goes through in medical school. I started with a pretty open mind and rotated through various things. I liked most of them. I liked medicine, I liked pediatrics. But during my pediatric rotation, I consulted on an appendicitis case in the emergency room. I called the surgeon—one of the busier guys I've ever worked with. He was actually the only pediatric surgeon at the University of Arkansas. He came down to the emergency room, and I presented the case to him. He didn’t like my presentation. He was very critical of me, said I hadn’t done my homework, didn’t understand the disease process, and that I should have been better prepared to present a case to him.
He was a sort of crotchety old guy, understandably, because he did about 1,500 cases a year with nobody else on call. I wasn’t used to being treated like that. I was a pretty good medical student, and typically I was prepared. So I dedicated myself to impressing this guy after that—to redeeming myself. That made me start going to the operating room. We actually became friends, and I would just go by the OR and watch what he was doing. I started watching a lot of pediatric surgical cases, and that’s what really got me interested in pediatric surgery specifically. I also realized I was much better suited to surgery—shorter rounds, making more acute decisions on patients, actually fixing a problem, getting more immediate gratification. So I think I naturally gravitated toward surgery in general.
Q: Looking back, what were some defining moments or challenges that shaped you as both a surgeon and a mentor?
A: I became interested in pediatric surgery at the end of medical school. Around that time, I came across some articles by Mike Harrison, the father of fetal surgery. He had just started doing experimental work on fetal lambs and had created and repaired congenital diaphragmatic hernia in them. I read those papers and was blown away. It seemed like the coolest thing on the planet. So I wanted to go to the University of California, San Francisco (UCSF) because of him. Coming from Arkansas, nobody got into UCSF. But I got lucky—I interviewed with Mike Harrison purely by chance, and I assume that’s why I got in. Their pattern was to take a Duke guy, a Johns Hopkins guy, a Harvard guy, and three UCSF guys every year. That year they took an Arkansas guy.
I thought I was a pretty good resident. I rotated on pediatric surgery with the intent of going into Mike’s lab, and I was the only resident on the service. I basically lived in the hospital for two months and worked my tail off. I thought I had impressed everybody. At the end of my second year—since we usually went to the lab after the third year—I went to Mike and said, “I want to work in your lab.” He looked at me very stone-faced and said, “You know, Alan, you didn’t impress me on the service.” I was shocked. Floored, actually. Then he said, “Why don’t you think of a project and come talk to me again, and we’ll decide whether you can come into the lab.” I had just assumed I would go into his lab. Looking back, I’m sure he was pulling my chain. I know now that I was a good resident and that I had impressed him. What he really wanted was to force me to come up with an idea—to pursue something I truly wanted to work on, rather than taking it for granted that I would go directly into fetal surgery research. So, with that motivation, I went to the library—nobody goes to libraries anymore—and I found what became the central theme of my research for the next 30 years: prenatal stem cell therapy and gene therapy. I came back to him with that idea. He said, “Well, that’s kind of a flyer, Alan, but it sounds great. Let’s do it.” And he brought me into the lab.
That was the beginning of an incredibly stimulating research career. I learned several things from that experience. First, don’t take anything for granted. You have to earn everything you achieve in life. Second, from a mentorship perspective, it’s important to motivate people—to push them to pursue what truly drives them. Ever since then, with my own research fellows, I’ve tried to let them choose what part of the fetal therapy work they want to pursue. I give them options; I don’t require them to come up with something entirely new, though it’s great if they do. I let them figure out what motivates them most. That approach has paid off. A large number of my trainees have ended up in fetal therapy because they were inspired and fired up by the work they did.
I learned a lot of my mentorship style from Mike Harrison. He never accepts dogma—not even his own. He questions everything and makes you convince him. And he has incredible, unbridled enthusiasm. His lab meetings were truly fun—full of energy, discussion, and excitement. That taught me how powerful it is to make people feel excited about innovation, about thinking differently, about rejecting dogma, and about deciding for themselves whether something is right. In the operating room, mentorship is different. There, it’s about teaching people to act on what they see—to make decisions and to technically perform surgery in a competent, safe way.
Another important piece of advice for mentees is that you need to impress your mentor. The more enthusiasm you show for what they’re doing and teaching you—and the better you remember the lessons they impart—the more enthusiastic they will be about teaching you. Not everyone does that. Some people don’t remember what they’ve been taught or don’t show the enthusiasm needed to motivate a teacher. But if you do, you’ll get so much more out of your training.If you show up when and where you’re supposed to, come prepared, ask questions, and show that you appreciate the mentorship you receive, you will receive far more of it—and far better-quality mentorship.
Q: You’ve worked with many talented women in surgery. What qualities have stood out to you, and how do you think mentorship can help support their continued growth and leadership?
A: Well, that’s a tough one because I’m a male, right? And it does break down somewhat into the different challenges that male and female surgeons face. I’m not sure a male can truly identify with many of the challenges that a female surgeon encounters. From my perspective as a male surgeon, when I work with female residents, I try not to be very gender-aware. I try to treat them very similarly to the way I treat male residents. I try not to show in any way that I am treating them differently as women, because anything else would involve making assumptions about them that I really can’t know for certain.
I admire female residents, fellows, and colleagues a great deal for the additional challenges they face. Many of them have children. Many have non-supportive spouses; some have very supportive spouses. I can definitely recognize the difference between those two situations. Some have a lot of family support, and some don’t. But I still try not to treat them differently. I make the assumption that their horizon is just as broad as a male fellow’s horizon—that they have all the same opportunities before them if they are trained, motivated, and want to pursue those opportunities.
And I’ve seen women with those additional challenges be incredibly successful in research, academics, and clinical surgery. Those challenges can be overcome. But I’m not sure I’m the right person to mentor them specifically related to those particular challenges. I do think female surgeons need both female and male mentors. They absolutely need female mentors, but they also need male mentors to take full advantage of the opportunities available to them in training and in learning their profession. Surgery is a male-dominated field. Many of the major figures in surgery are men, and you would be remiss not to pursue male mentors who can teach you surgery. Not only that, but male mentors may be as well-connected—or more connected in some circumstances—than female mentors you might seek out. So I think there is a role for both.
I think mentorship has to be thought of in different ways. There is research mentorship, which has its own set of considerations. There is surgical mentorship, which involves technical skill and decision-making. I can certainly guide a woman in technical aspects of surgery and many components of a surgical career. I can advise her if she wants to pursue a research pathway and tell her what needs to be in place for that to be successful. But I’m not going to be able to advise a woman on how to balance having a family she cares for while pursuing a surgical career. That would be presumptuous of me. So mentorship has its domains, and the types of mentors you need can differ across those domains.
My advice for female surgeons would be to seek out the best mentors they can find—regardless of gender—in each area of their professional development. It is absolutely essential to find women in surgery whom you admire and whose careers you can model to some degree. But it is also important to find the best mentorship in all areas, and that may very well include male mentors.
Q: What advice would you give to young surgeons or trainees who are just beginning their journey?
A: The advice I would give to someone who’s interested in surgery—or any career, really—is to find your motivation. You need to find something that truly inspires you, energizes you, and will continue to fire you up for the next 30 years of your career. I was very fortunate to find that in fetal surgery and fetal therapy. But I think that’s the key. Nothing about this field is easy. Even now, there’s nothing easy about it. It’s extremely demanding, and it will take everything you have to be good at it and succeed at it. You’ll be much happier if you find something you genuinely like. And it doesn’t matter if you have to train longer for it, and it doesn’t matter if there are more obstacles along the way. If you are truly driven by the specialty you choose, you’ll be a much happier person for it—and a much more successful person.
Q: You’ve had such an adventurous life outside of surgery, from fly-fishing to traveling the world. Is there a favorite story or experience that taught you something about life or medicine?
A: I think fly-fishing, in many ways, has a lot in common with surgery. It’s a hobby that requires focus, dedication, and a certain amount of technical ability. And it’s something you can immerse yourself in as deeply as you want. If you want to go all the way into the entomology, tying your own flies, doing all of those things—you almost become the fly, you become the fish. There’s a whole Zen aspect to it. There are many similarities to operative surgery. There is a Zen in the art of surgery as well. You almost become the structures in the body and the tools you’re using. If you really envision what you’re doing—I always tell residents: this is an operation that requires Zen. For example, portoenterostomy is an operation that requires Zen. You need to three-dimensionally visualize what you’re going to do. Just like athletes visualize their performance, surgeons should visualize what they’re going to do. You need to truly become one with the operation. I really believe that. And I think good, experienced surgeons reach that Zen state when they’re operating, where they don’t have to think very much. It becomes almost a sixth or seventh sense that warns you of trouble and keeps you out of trouble. It’s hard to describe, but it’s very real.
As for travel, what my international travels and interactions with physicians, surgeons, and researchers around the world have taught me is that there is an incredible amount to be learned from others. You can never reach a sense of self-accomplishment that should preclude you from having an open mind to other perspectives. There are so many talented, incredibly smart people out there who do things differently than you do. You need to listen to what they do, watch what they do, and learn from what they do. I have great international friends because I’ve always had that perspective. My biggest benefit from international travel is learning what other surgeons do and why they do it. It has added a lot to my own surgical career. So when you ask about events that shaped my career, I would group all of that together—having the opportunity to travel around the world, work with surgeons in many different settings, see how they do things, and learn from them. That has shaped the way I do many things.
Q: Outside of the operating room, how do you maintain balance and find joy in life?
A: Honestly, the whole work–life balance thing has always been challenging for me. It becomes even more challenging when you have people who depend on your balance—young children, family, and responsibilities outside of surgery that truly matter. As I mentioned earlier, if you find something that drives you, fascinates you, and keeps you pursuing it, then you find joy in the work itself. Surgery and research have brought me as much joy as anything else in my life. They are consuming, and I’ve never fully solved the balance question. When you have a family, you gain tremendous joy from them, and that is entirely outside of surgery. You need to spend the time you can, prioritize appropriately, and truly be present. I didn’t have a lot of time with my children, but I had quality time—meaningful experiences and trips that we all remember. Even though I spent less time with them than many fathers do, I don’t think they ever felt neglected, and we remain close.
It has always been a struggle. I don’t know how to be the perfect husband and father while also having a big research career and a demanding surgical career. These are conflicting commitments, and I’ve prioritized them differently at different times. Sometimes you have to compromise. Many people eventually face a decision point—maybe choosing not to do research to focus on clinical work and family, or reducing other commitments to create balance. If balance is your top priority, you probably can’t have a full-time surgery career, a full-time research career, and a full-time family life without compromise. You need to set realistic goals for what will matter most to you. That’s not easy when you’re young and don’t yet know how your priorities will evolve, but being thoughtful about your expectations early on can help you navigate your career and personal life with more clarity.
About the Interviewer
Lillian J. Lee is the Mid-Atlantic Regional Representative for the AWS National Medical Student Committee and a third-year medical student at the CUNY School of Medicine. She also serves as a 911 EMT in Brooklyn South, where caring for children during trauma and emergency calls showed her how vital early diagnosis and timely surgical care are in preventing life-threatening situations. These experiences, together with her visual arts background and love for hands-on work, shaped her goal of becoming a pediatric surgeon and improving global access to safe, timely, quality surgical care for children.
Lillian works under the mentorship of Dr. Alan Flake, an internationally recognized leader in pediatric surgery who has played a central role in her academic and research development. Dr. Flake collaborates with her on an international biliary atresia research initiative that brings together centers in the United States, Hong Kong, and Japan to improve surgical outcomes for children. His guidance and his commitment to supporting trainees have been instrumental in her growth as a future surgeon and global health advocate.
Motivated by her clinical experiences and mentorship, Lillian founded the first Doctors Without Borders and Socially Responsible Surgery chapters at her medical school to promote humanitarian engagement, cultural awareness, and global health education. Through her advocacy and fundraising, she hopes to continue supporting children and helping ensure that every child has the chance to live a healthy, happy life. In her free time, Lillian enjoys lifting weights, spending time outdoors, and caring for her German Shepherd, Chun-Lee.