Bob Carter, MD, PhD, operates on a patient
After completing his residency at Mass General in 1999, Bob Carter, MD, PhD, came back to the hospital as the Chief of Neurosurgery in February, 2017. As he reflects on the first year in his new position, Dr. Carter discusses what made him come back to Mass General, recent research projects he's worked on, his long-term vision for the Neurosurgery department and more.

What were some things you saw during your residency at Mass General that made you want to come back as the chief of Neurosurgery last year?

One of the things that attracted me to Mass General as a resident was that the staff are both collegial and highly competent. Everyone is focused on the quality of the outcomes and working in highly collaborative teams. That speaks to the professionalism of the group. The institution, historically, has also emphasized a depth of excellence as opposed to just being a big hospital.

I felt like this was an incredible community. The medical ecosystem of Boston is really unique with Harvard, MIT and all the great hospitals here.

Also, if you look at NIH spending, Massachusetts is at $381 per person. The next closest are New York and California, which are in the $200s. We have more dollars of biomedical research spending per citizen in Massachusetts than any other state in the nation. If you're a person who wants to be involved in biomedical advances, this is the place to be.

What do you want both your residents and your current staff to take away from their experience at Mass General?

If you want to be a leader in your neurosurgical practice, this is a great place to train. We train more department chairs than any other program in the country. There are currently 10 neurosurgeons who are leading neurosurgery departments in the United States from this program, more than any other program today.

I think the reason people from Mass General are selected as leaders is multifaceted. While here, they get exposure to the cutting-edge of neurosurgery. When they go to their new institution, they're leaders because they've seen and practiced with the latest advances. That excellence mixed with the diversity experienced here is a powerful combination.

How do you prioritize what paths you follow in your research?

I've been fortunate in that the things I've worked on have been advances for patients. I want to study things that can improve quality of life or help find a cure.

The research we do is very patient-focused, and that's one special aspect of Mass General. We're part of a large university, but we're not on-campus, so we have our own ecosystem. We obtain $800 to $900 million per year in research dollars, but what’s most important is that we try to be patient-focused with our projects.

Can you talk about one or two research projects you've started since coming back to Mass General?

I had some early projects during my residency and faculty years that were related to CAR T cell therapies for cancer. It's interesting to me that the project I worked on as a resident more than 20 years ago is now the hottest new therapy. I enjoy seeing that evolution. It started as a concept, and we wrote some early papers on it, and now it's blossoming. It hasn't quite taken hold on brain tumors yet, but it's moving in that direction.

I think our recent work on exosomes has also been interesting, along with liquid biopsy. Again, it's been fascinating to see that move from almost no articles in 2008 to now, 10 years later, there are thousands of articles on it, and it's getting discussed at conferences all over.

What's been your most interesting or surprising finding in the research you've done recently?

It's not necessarily surprising, but it’s just understanding how complex cancer is. We think of strategies to beat it, but it has ways to thwart our best efforts. Coming to that realization that we need the best minds and the best approaches in combination to beat that disease is really important.

In terms of novelty, the fact that exosomes, these small packets released from cells, can carry RNA and protein and completely manipulate the microenvironment was something that wasn't taught to us at medical school. That was a discovery that came about here at Mass General that informs the way we look at the body and how disease works in the body.

What made you decide to pursue neurosurgery?

I made the decision during my fourth year of medical school, and I could actually take you to the exact moment. I was watching the removal of a foramen magnum meningioma with the department chair at Johns Hopkins, and it was incredible. The neurosurgical resident couldn't scrub in, and I was the only one who could assist. It was a great experience. 

I was also drawn to the challenge of taking on tough problems and realizing the challenges of neurological illness were so significant that it could be stimulating over the lifetime of my career.

We've made a lot of progress, but there's still a long way to go. I'm just as engaged now as I was when I was younger.

In terms of staff, your department has grown quite a bit—you've added four people to a staff of 18. What is your long-term vision for the department?

Our dream would be to use Mass General to build a network of neuroscience communities that allows us to care for a broader population in an efficient and high-quality fashion.

We'd love to see partnerships with our regional hospitals, which could result in joint programs or bring together doctors to work at those facilities and have certain types of care done here at Mass General. I think that's the next step.

We've always been a referral center, but to become a coordinated and integrated neuroscience network would be great.

What's your 30-second pitch to a doctor you want to recruit to Mass General?

You'll have a chance to fully realize your dreams on both a clinical and investigative profile. You’ll have the chance to come and work with the best. If we select someone to come here, it's because they've shown creativity, endurance and an ability to make a team come together. 

That's part of why I came back—the incredible teamwork that we have here.

What about the 30-second pitch to patients?

Patients know that when they come to Mass General, they're going to get a very high-quality effort to give them the best outcome. When they walk in the door, they may be grappling with a new and uncertain diagnosis, but they can be reassured that if they're at Mass General, their surgeon is one of the very best.

Patients know there won't be any stone left unturned. We're going to use every available technology, method and surgical procedure to produce the best possible outcome.