Our younger readers may not be familiar with the Berry Plan and the importance that it played in the lives of many surgeons like myself who trained in the 1970s prior to the conclusion of the Vietnam War. Memories of my personal involvement in Navy Medicine have been stimulated by the COVID-19 pandemic involving the Nimitz-class nuclear aircraft carrier, USS Theodore Roosevelt (CVN-71). The ramifications of this story, as only one of many pandemic-related vignettes, are many and far-reaching. Not only does it highlight the dangers shared by people living in extremely close quarters, but also emphasizes the fallout when an individual, who means well, goes outside the “chain of command” to seek help. As one of the last Berry Plan surgeons in the Navy, I read this story with greater interest than the casual observer. As a newly trained general surgeon in July 1976, my first duty orders directed me to serve as the surgeon for the first deployment of a Nimitz-class nuclear carrier, USS Nimitz (CVN-68)
What was the Berry Plan and what do we know of its founder? Born in Dorchester, Mass., Dr. Frank B. Berry received his undergraduate and medical degrees from Harvard. He initially trained as a pathologist at Brigham and Women’s Hospital, in Boston, but his career was interrupted by service as an Army pathologist with the American Expeditionary Forces in France in World War I. He ultimately decided that he really wanted to be a surgeon and completed his surgical training at Bellevue Hospital, in New York City, where eventually he served as the director of one of the surgical services at Bellevue and on the clinical faculty at Columbia University.
In 1953, he was appointed Assistant Secretary of Defense for Health and Medicine by former President Dwight D. Eisenhower. By his own account, he related that he took that position because of an increasing tremor in his left hand that caused him to question his ability to continue as a practicing surgeon. Shortly after assuming his post, Dr Berry thought that “we might devise a doctors’ draft with fairness to all, including the medical schools, the hospitals, and the greater organizations which were objecting to the drafting of doctors-the American Medical Association, the Association of American Medical Colleges, and the American Hospital Association” (Berry FB. The Story of the “Berry Plan.” Bull NY Acad Med 1976;52:278-282).
The “plan” offered three choices. Those physicians who desired to serve in the military must first choose a service (I chose the Navy) and could: 1) serve immediately after internship, 2) serve after one year of residency following internship (PGY-2s), or 3) were allowed to complete full residency training. Each of these choices was followed by two years of obligated active duty service. Although it was felt by Berry and his colleagues that the second choice would be most desirable, it turned out to be the least popular of the three. The most attractive option was the privilege of a full deferment for residency training in a civilian hospital. Unfortunately, we were generally not given a choice.
As it turned out, I was offered the second option initially and prepared to leave my academic training program after two years of training. As luck would have it, in the spring of my PGY-2 year, I was notified by the Navy that I would not be needed at that time and, instead, was given a full deferment for training in general surgery. The unfortunate part of this story was that I had already given up my residency position in anticipation of my military service. We had a traditional pyramid program at Yale, and, therefore, I was without a position beginning in July of that year. Thankfully, my surgical chairman offered me a one-year laboratory appointment as an alternative with the opportunity to return to my clinical rotations the following year.
Now here is where serendipity or, alternatively, “beshert” (a Yiddish term) comes into play! I had started out planning to train as a cardiac surgeon after my general surgery residency. The lab year offered by my chairman was supported by the American Cancer Society and would involve research in gastrointestinal malignancy. That experience—working at St. Marks Hospital in London and learning how to perform a colonoscopy—completely refocused me toward surgical oncology, a decision that I have never regretted. It was the exigencies of the Berry Plan that gave me that opportunity.
My time on the USS Nimitz as its surgeon was one of the highlights of my life. During those eight months at sea, I learned what it meant to be on a floating city with almost 6,000 men. Women were allowed to serve on carriers only years later. After my year on Nimitz, I completed the second year of my Berry Plan obligation at the Naval Medical Center, Portsmouth, Va. Many of my fellow surgeons accompanied me to these academic military training facilities. It was at Portsmouth Naval that I honed my thoughts as to what a well-run academic surgical training program should look like. The Berry Plan experience has stayed with me and has shaped every facet of my surgical career.
Dr. Berry died at the age of 84 in Providence, R.I., on Oct. 14, 1976. I was a “Berry Planner” cruising in the Mediterranean Sea on board the USS Nimitz and, on that very day, was probably living the dream in our OR.
Dr. Greene is a surgeon in Charlotte, N.C.