Skip to content Skip to footer

Surgeon Spotlight: Dr. Milton Armstrong

Written by Showly Nicholson, Harvard Medical School MSII
Edited by Derek Banyard, University of California, Irvine, Plastic Surgery PGY2

Welcome! This is the first of the Garnes Society Surgeon Spotlight Series where we feature the story, experience, and advice of one of our members within the fellowship. For our inaugural spotlight, we are excited to introduce Dr. Milton Armstrong, Professor & Chief of Plastic, Reconstructive and Hand Surgery at the Medical University of South Carolina in Charleston, South Carolina. We spoke with Dr. Armstrong regarding his career path, his motivations for remaining in academic medicine, his perspective on diversity and inclusion, and his insight into preliminary discussions concerning the pass/fail change to the USMLE step 1 exam set to take place in 2022.

Upbringing and Medical School

Dr. Armstrong was born in St. Louis, Missouri, and grew up in the poor, predominantly black neighborhood of East St. Louis, nestled on the Mississippi River, just across from Gateway Arch National Park. He is one of three siblings and the first of his family to pursue a career in medicine. His parents were extremely hard working; his father was a laborer and his mother, a beautician. They placed a strong emphasis on education and their watchful eye was critical to keeping him and his siblings out of trouble. Despite high academic achievement that earned Dr. Armstrong a full-scholarship to the University of Illinois, Champaign, IL, he would still get questions from his white classmates like, “how’d you get in here?” In addition to preparing him for questions like these, his parents instilled in him the mental rigor and work ethic that allowed him to earn a full academic scholarship to Southern Illinois University School of Medicine, Springfield, IL.

Early on, Dr. Armstrong developed an interest in cardiology, and even received scholarships to pursue the field. However, his excitement waned after completing his internal medicine rotation. Fortunately, this feeling of career uncertainty didn’t last long. His next rotation was general surgery and he immediately found a spark. He fell in love with the idea that surgery provided far more opportunities to actually cure disease as opposed to managing a patient and their disease process which is more commonly found in primary care and its specialties. Based on a fascination with hand anatomy that he developed during his first-year anatomy class, he decided to pursue a career in orthopedic surgery. During the final year of his accelerated 3-year medical curriculum, he was given the opportunity to complete a 1-week elective rotation with the plastic surgery service. He worked under Drs. Elvin Zook and Robert Russell and was blown away by the diversity of surgical cases, and was specifically impacted by the enjoyment these surgeons took in their work. Despite being a strong applicant and having completed away rotations in orthopedics, Dr. Armstrong failed to match into the specialty, and ended up matching into general surgery in Pittsburgh at Allegheny General Hospital.

Learn more about Dr. Armstrong in a video interview here.

Path to Plastic Surgery and Division Chief

The general surgery residency at Allegheny General Hospital in Pittsburgh was a high-stakes pyramid program where many residents were not renewed for further training at the end of each year. “Not only did I have to work 100+ hour work-weeks,” he said, “. . .but I’d have to keep my mouth shut and head up while I was at it. One significant complaint against me could mean I wouldn’t be returning next year.” Dr. Armstrong enjoyed the autonomy in his program where he was able to create junior resident elective rotations that were structured towards a career in Plastic Surgery. These included a Burn Surgery rotation at West Penn Hospital, Pittsburgh, PA and a Plastic surgery elective at the University of Pittsburgh in the Division of Plastic Surgery. He had excellent plastic surgery mentors including Drs. William Swartz, William Futrell and Neil Jones. He was provided the opportunity to rotate at the University of Pittsburgh where he got to do both emergency and elective cases with the plastic surgery attendings and fellows. He also completed 1 year of plastic surgery research under the auspices of Dr. Frederick Heckler.

During the 4th year of his general surgery training, Dr. Armstrong attended the American College of Surgeons meeting in New Orleans. He was delighted to run into Dr. Swartz who had recently left Pittsburgh to start the plastic surgery training program at Tulane University. Dr. Armstrong vividly remembers Dr. Swartz pulling him away from the conference center for a 4-hour discussion and tour of Tulane’s medical campus; little did Armstrong know he was being interviewed for his dream residency program. Soon after his return to Pittsburgh, he was scrubbed-in assisting a pancreatic resection when the OR phone rang with a call for him from New Orleans. He had to mask the excitement that he was just offered a plastic surgery training spot at Tulane, so as not estrange his attendings who, at their core, were hardcore general surgeons.

Dr. Armstrong was surprised by how well he acclimated to life in New Orleans. While it was a culture shock, he found that most people were nice and cordial. He also found that life was easier to navigate as a young black man in the deep south. If someone did not like you or were prejudiced against you, they simply wouldn’t speak to you or share your space. This was big change from the covert racism that existed in the Midwest that made it difficult to know who one could trust. His most memorable residency experience occurred early in his training program when he was running the resident cosmetic clinic and an older white female patient presented for an abdominoplasty consultation. He will never forget the conversation:

Patient: “Are you going to do my surgery?”

Dr. Armstrong: “Yes ma’am”

Patient: “Have you ever done this before?”

Dr. Armstrong: “No, but I’ve read about it and been involved in a lot of tummy tuck cases”

Patient: “OK, well do a good job”

Dr. Armstrong was relieved to discover that he could receive most patient interactions at face value, and that at the end of the day, its hard work and outcomes that matter most. He would go on to complete a Hand Surgery Fellowship at Baylor College of Medicine/St. Luke’s Episcopal Hospital in Houston prior to beginning his career as an academic surgeon.

Dr. Armstrong’s first faculty position was at Ohio State University College of Medicine in the Division of Plastic Surgery, where he worked for nearly 9 years. In addition to his clinical duties at Ohio State, Dr. Armstrong served as Associate Dean for Student Affairs (1997-1998) and Associate Dean for Minority Affairs (1998-1999). During this time, he was the only black faculty member, in the department of surgery and also got the sense that his chance for promotion to a higher leadership position at Ohio State was limited.

He then joined the University of Miami as the only black faculty member and served as Chief of the Division of Plastic Surgery at the Veteran’s Hospital. This is where Dr. Armstrong truly began to realize his potential as an academician. He started both a microsurgery and a hand surgery fellowship, and published a number of academic articles and a textbook of lower extremity surgery.

In 2009, Dr. Armstrong discovered that the Division of Plastic Surgery at the Medical University of South Carolina was seeking a Division Chief. Despite having some reservations about South Carolina’s historical and ever-present ties to the Confederacy, Dr. Armstrong was impressed at the racial diversity that seemed at the core of MUSC’s mission. Dr. Armstrong has been Professor and Chief of Plastic Surgery at MUSC for the past 11 years, and proud of the 100% board pass rate that his residents have achieved under his watch.

On His Experience as an African American Surgeon

Dr. Armstrong was pleasantly surprised by the current culture at the Medical University of South Carolina which he describes as “progressive and diverse,” with more black faculty than at any institution where he’s trained or worked. In his experience, “Patients base their trust on whether or not you’re a good surgeon.”

With that said, we asked Dr. Armstrong about the phenomenon of black faculty sometimes being hired to fill the checkbox for “diversity” without the freedom to make change in their department and/or academic institution. “Diversity and Inclusion are two different terms” he replied. “Although black physicians are hired and represent diversity in a department, they have to be included as well. They have to be part of the conversation for change and to be listened to; they have to be in positions of power to make a difference. In many cases, you need longevity in a department for this to occur. One needs to obtain tenure.” He also mentioned that anecdotally it has seemed that black women have faced this problem more so than black men, especially in surgical specialties.

On Why He Stayed in Academic Medicine

Dr. Armstrong has many reasons as to why he has chosen to stay in academic medicine. The first is the fulfillment he finds in working with medical students and residents. He enjoys teaching, mentoring, advising, and training. It is a unique experience guiding a trainee to maturation as a surgeon. “I can influence society by training good surgeons more than I can in private practice,” he said. To date, he has trained over 100 surgeons throughout his career, and the thought that these practitioners have embarked on their career to be caring clinicians, serving patients, hardworking colleagues, and advocates for diversity and inclusion gives him satisfaction and purpose. Additionally, he has noticed that black private-practice surgeons do not always reap the fiscal benefits as compared to their non-black counterparts.

Opinions on Step 1 Becoming Pass Fail in 2022

According to Dr. Armstrong, there is some consensus that the Step 1 USMLE exam moving to pass-fail is not going to hold for subspecialties, since its scores correlate strongly with in-service exams and program directors use it to gauge the potential success of incoming classes. He foresees students having to take the USMLE Step 2 exam earlier, so programs will have an objective score to compare applicants. Lastly, there will be a stronger impetus to publish research, and there may be an increase in Plastic Surgery Departments hiring students from their home institution.

For students who have a low Step 1 score with aspirations to match into plastic surgery, Dr. Armstrong recommends using outside rotations and research experiences at outside institutions to get faculty support for the application process; it is critical to gain the support of well-known faculty members prior to the application process.

On the Status of Independent Training Programs

The Medical University of South Caroline has both integrated and independent training programs. When Dr. Armstrong was asked about the status of independent programs, which are dwindling to make room for more integrated programs, he responded that there is always value in the independent model. He believes there will always be talented general surgery (and other) graduates who are eager to train in plastic surgery. He believes that in many ways, independent residents are tested and more reliable. As long is there is demand for the independent model, MUSC will continue to offer it as a training construct.

Advice to medical students

The most important factor determining the trajectory of Dr. Armstrong’s career has been the reputation that he has developed and the connections with colleagues he has maintained over the years. To medical students he recommends “developing relationships with others in the field by going early to work, staying late, being reliable, studying all aspects of medical science, and keeping lines of communication open. Show yourself to be a hardworking, intelligent and inquisitive student. It is very important to maintain a professional demeanor throughout one’s career.