“The number of applicants from the US is larger than we have ever seen before”: Sean Cleary on why he left the Mayo Clinic to expand robotic surgery in Toronto

Who: Sean Cleary, 52, chair of general surgery, University of Toronto, and hepatobiliary and pancreatic surgeon, Toronto General Hospital Known for: Working to expand robotic surgery in Canada Moved from: Mayo Clinic in July of 2023

You left Canada for the US during the first Trump administration. What prompted the move? I was on faculty at the University of Toronto at the time and had gotten an offer from Mayo Clinic in ­Rochester to serve as professor of surgery and as division chair of hepatobiliary and pancreas surgery, among other things. My wife and I told our children in October of 2016 that we were moving to the States, and a couple of weeks later the Republicans won the election.

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Was there culture shock? We managed. We were living in Minnesota, which has a fairly strong Democratic base in the urban areas and is Republican in the rural areas. As a family, we had a strict rule not to comment on politics—we told our kids that no one wanted to hear from the ­Canadians—and I had an equally firm policy not to get drawn into political discussions at work. Being there made me appreciate the strength of the Canadian health care system. Canadians like to complain about their health care, and there’s political commentary south of the border that relishes in pointing out the weak spots in the system for political advantage. But the reality is that, from an educational research perspective and even a medical care perspective, the Canadian system does an exceptional job 98 per cent of the time. U of T is world-class—our department of surgery is ranked in the top five internationally by US News and World Report. And Toronto General, which is part of the University Health Network, is ranked number three internationally by Newsweek.

Apparently Mayo Clinic has the edge—Newsweek ranked it number one. Working at Mayo Clinic was a fantastic opportunity, but it was the right time for our family to come home. The kids were finishing high school, and they both decided on Canada for university. We could see another turbulent four years on the ­horizon—the election results were more of a foregone conclusion in our minds than in other people’s.

What makes U of T and UHN world-class, in your opinion? There is a strong academic infrastructure that supports the hospitals. In the US, the universities and hospitals have taken an increasingly financial approach to their relationship. Here, our hospitals and universities are associated but not linked financially, so they come together for strong research and academic outcomes. I welcomed the ability to return to a system where I didn’t have to make decisions on care based on insurance status and where the financial performance of the institution wasn’t always the paramount thing.

You’re the chair of general surgery at U of T. What does that position entail? I support the entire division of general surgery, so roughly 165 surgeons across nine hospitals in the GTA. We have one of the largest training programs in North America. We’re working to bring robotic surgery into surgical care—not only in Toronto but across the province and the country. We’re behind other nations in terms of the expanse and utilization of robotic surgery, so we have some catching up to do. I’m leveraging the experience and relationships I built in the US to make that happen. I also do research on liver cancer genetics, looking at genetic drivers of tumour behaviour and screening for cancers using circulating tumour DNA, which is a non-invasive way of detecting and monitoring cancer progression. There are draconian cuts to medical research and funding happening right now in the US.

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Do you feel like you’ve been watching respect for your field plummet in real time? During the first Trump administration, there weren’t a lot of heavy-handed health care decisions, and during the Biden administration, there was strong support for the National Institutes of Health. But I was down there during the Covid pandemic, so I had a front-row seat to the difference between how the US and Canada handled things. The progressive undermining and criticism of science was disheartening and unsettling. Now we’re seeing that go to another level. I know people who have had clinical trials—real, practical things—put on hold. There were signs that a second Trump administration wouldn’t have the same concerns about maintaining a profile that would allow him to be re-elected, but I didn’t anticipate this extent.

You were recently in LA for a conference. How was the mood? Terrible.

Have you heard from colleagues looking to leave? As chair, I am involved in faculty searches, and the number of applicants from the US is larger than we have ever seen before. We’ve had Canadians working in the States looking to come back and born-and-raised Americans reaching out.

Was there a specific moment that crystallized your own desire to depart the US? I took my car to get serviced in Rochester, and Fox News was playing on TV. I tried to ignore it, but I just couldn’t sit there. I ended up grabbing a cab rather than waiting any longer. It wasn’t a calculated decision; it was a visceral reaction to those kinds of conversations. As a foreign national, you try to stay out of it, but you’re still around these conversations. We even grew apart from friends there because of the discourse. We didn’t argue, but we definitely felt like outsiders. It’s sort of like chronic pain. You’re surrounded by it all the time. It never goes away.