Lewis First | Vermont Medicine Magazine | UVM Larner College of Medicine

(Above) Dr. Lewis First poses at the television studio where he records his health tips show.

If you raise or care for a child in Vermont or upstate New York, you likely know of Dr. Lewis First. You probably have listened to or watched “First with Kids,” the long-running weekly health tips segment he writes and hosts for local radio, television, and community newspapers. You may have seen or heard him as a spirited participant or emcee at community events to benefit children and families in the region. And if a child you know ever needed hospital or specialty care, it’s a fair bet you encountered Lewis First, M.D., M.S., at UVM Children’s Hospital.

As he marks his 30th year as chair of pediatrics at the University of Vermont and chief of pediatrics at UVM Children’s Hospital, Dr. First reflects on his career journey, the choices he made along the way, and the legacy he continues to build. By Janet Essman Franz

With his penchant for Mickey Mouse ties, rewriting silly song lyrics, endless puns, and “dad jokes,” pediatrics seems like it must have been a natural fit for Lewis First from the start, but that wasn’t what his family intended for him.

Growing up in Philadelphia with a great-uncle, father, and paternal uncle who were obstetrician-gynecologists (and a medical librarian mother), there was a strong desire for Lewis First and his brother, Ken, to join the family practice. But young Lewis could not stand the sight of blood or the sounds of pain: As a teenager, he promptly fainted while witnessing his father deliver a baby, perform a cesarean section, or suction mucous from a crying newborn.

He was determined to prevail, however. At age 16 he volunteered in the emergency room trauma bay at Thomas Jefferson University Hospital as a means of overcoming his syncopal difficulties, which he successfully accomplished. More importantly, First also learned about the varied backgrounds and life experiences of the patients he encountered in that emergency department, and he began to develop the sense of cultural humility and appreciation for patient- and family-centered care that is vital to his practice and leadership today.

First came to the University of Vermont in 1994 from Boston Children’s Hospital with his wife, Sandy, and their two young children, David and Rachel, accepting positions as professor of pediatrics, department chair, and pediatric hospitalist. Shortly after his arrival, he visited every pediatric office in Vermont and upstate New York to establish and strengthen relationships with all pediatricians served by the college of medicine. Over the years, he has cared for patients in emergency, primary care, and inpatient settings, enabling him to relate to the many different aspects of overseeing the department and children’s hospital and listen to the needs of patients and clinicians. He strategically led the ongoing expansion of the department and its clinical services and the branding of the University of Vermont Children’s Hospital as “a children’s hospital without walls” across the UVM Health Network.

In 2003, First was named senior associate dean for medical education, a position he held for seven years while continuing as department chair, and helped implement the Vermont Integrated Curriculum, which integrates active learning with basic and clinical sciences. He continues to teach and mentor trainees using creative methods that have garnered him accolades and honors, including the rank of Distinguished Educator in the Teaching Academy, the Association of American Medical Colleges Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award, and the George V. Kidder Outstanding Faculty Award for excellence in teaching from the UVM Alumni Association.

In 1995, First launched “First with Kids” on radio station WOKO 98.9 FM, delivering evidence-based tips for keeping children and adolescents healthy—with his special brand of humor. NBC5 picked up the segment for broadcast on morning and evening television newscasts and it is syndicated for publication in 15 community newspapers, making First a celebrity in the region. In 1999, he further applied his literary skills as the author of several textbooks and was the inaugural editor of AAP Grand Rounds, a monthly newsletter of the American Academy of Pediatrics. He became editor-in-chief of the peer-reviewed journal, Pediatrics in 2009. Well respected among the medical community, First has been a popular presenter and keynote speaker at national and international conferences.

“Lewis First is an icon. He’s a master clinician and brilliant educator. He has touched the practice of every pediatric care provider in our state and region and educated countless members of the community through his wisdom and wit, says Larner College of Medicine Dean Richard Page, M.D. “Under his leadership for 30 years, the Department of Pediatrics has become nationally and internationally recognized for its excellence.”

Today, First is the longest lasting current pediatrics department chair in the United States. He oversees a network department spanning the six UVM Health Network hospital sites and five outpatient pediatrics primary care sites serving approximately 225,000 children across Vermont and New York, with nearly 110 pediatricians and advanced practice providers, 300 nurses, 50 support staff, and 60 patient-family advisers, and more than $10 million in research funding in 2023 that includes basic, translational, and clinical science and quality improvement studies.

Dr. Lewis First in his office at the UVM Larner College of Medicine

First focuses on work in his office at the UVM Larner College of Medicine.

Leadership and Service
First is the third chair of the department, following R. James McKay, M.D., the founding chair, who served for 33 years starting in 1950, followed by Carol Lee Philips, M.D., who served for 10 years. Stepping into this role was humbling, First says, and he made it his mission to carry on the original doctrines of Dr. McKay, who had instructed department faculty to always be gentle, respectful, understanding, sympathetic, and kind.

First established a new set of principles for faculty to apply these qualities: They must strive to be national or international leaders in the field of pediatrics, through either clinical work, education, research, or advocacy; they must act to improve the communities they live in through volunteering and service; and they must love caring for children, not just as a job but as a calling. These tenets are important to the department’s visibility and enable it to grow its academic and clinical mission locally, nationally, and internationally, First says.

“When we’re out there volunteering, educating, taking leadership roles, and advocating for child health improvements, people see us embedded in the region and realize how much we care for our patients, and they appreciate having a children’s hospital and pediatrics department that is here for them,” says First. In 2014, because of the department’s accomplishments, First received the Joseph W. St. Geme Jr. Leadership Award, the highest leadership award given nationally in academic pediatrics.

Since 2020, First added three more tenets for his team: Everyone must help improve health disparities through their work in diversity, equity, inclusion, and social justice; take time for well-being activities; and make sure the department culture is sustainable for those who follow. Department meetings always include reflections of gratitude, and all educational gatherings contain an “equity slide” focusing on how health care disparities play a role in illness diagnosis or treatment. “We educate ourselves in what it means to be antiracist, be a gender equity ally, understand the stigma of weight, disability, or when English is not your primary language, and then act to reduce these disparities in our interactions with patients and each other,” he says.

First personally meets annually with faculty on campus to discuss their work in the community and their career aspirations. He wants to know what they enjoy doing on and off the job and how the department can support them in achieving their aspirations. Faculty and staff say Lewis’s guidance cultivates their own well-being.

“When I interviewed for residency at UVM Children’s Hospital, I could tell that he was the kind of leader who fostered a culture I wanted to be in. He is so thoughtful about relationships and focusing on the value of people,” says L. E. Faricy, M.D., assistant professor of pediatrics and attending physician for pediatric pulmonology. “I always feel seen as a person and not just an employee. He puts time and effort into building relationships with people and the community in a way that I emulate, with a constant focus on what’s best for children.”

Sue Victory, who has worked for every UVM pediatrics department chair during her 46-year administrative career in the pediatrics department, emphasizes First’s visionary skills and supportive demeanor. “Lewis has a way of encouraging people and making them want to excel and to reach goals. He helps people succeed, and he applauds them for it. He has done that for me, and for everyone else, including staff, faculty, division directors, residents, and students,” Victory says, noting that he starts every meeting with expressions of appreciative gratitude for a person, program, or division accomplishment and always injects his sense of humor. “People appreciate that he can be both very serious and also lighthearted at appropriate times.”

Creative Outlets
As an undergraduate biochemistry major at Harvard College, First made a point to take as many non-medical courses as he could fit into his schedule. He took history, philosophy, anthropology, psychology, and economics courses because “I love learning, reading, the creative use of words, and humanistic interactions with people,” First says. He worked his way into a job on the college newspaper (pre-med students were discouraged from such extracurricular activities) and gave campus tours, through which he honed his skills as an entertainer. “My tours were my performance art. Telling stories about the college buildings and history was fun.”

As a medical student at Harvard Medical School, First lived with three classmates with whom he wrote skits and musical numbers for the Second Year and Fourth Year class shows, the campy, irreverent Harvard tradition tapping theatrical talents of students. First enjoyed writing parodies of Broadway show tunes and performing as a lounge singer. “During intermissions I walked through the audience doing song parodies,” he recalls, adding that this talent has proven useful in professional settings. To this day, when First gives a national talk or grand rounds, he sings show tunes with lyrics he rewrites for the occasion.

Until his third year of medical school, however, First did not realize that he could incorporate his fun, creative side into his serious work. A senior resident teaching the pediatric clerkship rotation showed First that one could take patients and illness seriously but with a dose of humor and creativity.

“It was my last clinical rotation, and I was apprehensive about communicating with children who were ill,” First recalls. “The resident said very seriously, ‘I expect you to present a patient perfectly, in three minutes or less’ and called on me. I sheepishly presented the case of a boy who was wheezing. The resident turned around, put on funny moustache glasses, and said in a Groucho Marx voice, ‘Was it a wheeze, or was it a sneeze?’ He was a hoot and a half, and he taught me how to manage asthma at the same time!” The same resident later had a cold, and the nurses reminded the team to wear protective masks during patient rounds. “He took us on a field trip to buy us funny masks. I thought, ‘Oh my gosh, he can be humorous and caring and demonstrate enormous command of pathophysiology underlying pediatric illnesses!’ The chance to be creative and at the same time be a scientist, a clinician, a teacher, and a compassionate caregiver is why I chose a career in pediatrics.”

The spectrum of caring for patients from day one of life to young adulthood fascinated First, along with “the ability to go upstream in caring for patients,” focusing on preventive strategies to keep children healthy rather than only treating them when they are sick.

First joins the fun at events benefiting children and families.

First established a new set of principles for faculty: They must strive to be national or international leaders in the field of pediatrics... they must act to improve the communities they live in... and they must love caring for children, not just as a job but as a calling.

Paying It Forward
The lessons First learned as a teenager volunteering in a diverse Philadelphia emergency room, as an undergraduate scholar and tour guide, and as a medical student remain embedded in his interactions with others, including young people exploring careers in medicine. He dedicates department funding and his own time to a program led by Larner students called URiM (underrepresented in medicine) Pathways to Pediatrics, giving a glimpse of medical school to undergraduate students who self-identify as being underrepresented in the field of medicine. First mingles with participants and leads “Clinical Mystery Case” sessions to help them understand how pediatricians think about solving a problem. It’s just one of many examples of First’s commitment to medical education and creating opportunities for others to excel.

“Being able to introduce undergraduate college students who self-identify as under-represented to the field of child health is a meaningful experience for all involved, especially when it results in attendees considering pursuing a career in pediatrics that they may never have considered before,” First says. “Many of these students stay in touch with people they met from our department, helping us build a pathway for underrepresented child health professionals.”

Class of 2024 medical student Kiana Heredia created URiM Pathway to Pediatrics in 2022 with an aim to support students who feel doubtful about their ability to succeed, as she says she once felt. Getting to know First has been integral to her personal and professional growth and success. “Dr. First taught me to have faith that there are people out there who believe in you. He has shown me the richness of not only mentorship but also sponsorship. I appreciate him for providing me with a safe space and room to breathe,” Heredia says. “Dr. First is extraordinarily personable and down to earth. We can chat about anything from academics and life goals to the next best thing to watch on TV.”

What to watch on television is one of First’s favorite topics at staff and faculty meetings. At morning reports, he encourages participants to share what they did for fun outside of the workplace and shares his antics on the golf course and stories of family activities. He encourages department personnel to participate in wellness challenges hosted by the pediatric chief resident, sharing photos of themselves completing tasks like taking a hike, playing with a pet, or having fun with their work team.

“Rather than struggling to juggle our careers, family and friends, and personal interests, we try to make the space where those areas overlap as large as possible,” says First. “Knowing that overlapping space can exist is a formula for wellness for ourselves and for the patients we take care of.”

A personable mentor and creative teacher, First has earned numerous accolades for medical education.

Elevating Impact
While humor provides an anchor, there are times, First says, when he is the most serious person in the room. “I don’t use humor if it’s sarcastic or cynical. Humor is my ‘white coat,’ it’s a sign of my professionalism. It’s my commitment to shape what I do relative to the needs of the patient or the room I am in.”

On a recent day in the Children’s Specialty Center, while First chatted with staff at the reception desk, a young patient waiting to be seen and their caregiver caught his attention. First addressed the child and caregiver by name and assured them he had not forgotten about an earlier conversation. He promised to follow through, and the caregiver expressed confidence in his words. It was clear that First knows the patient, her family, and her plight.

Reflecting on his accomplishments during the past three decades, First points to the high quality of care his team provides daily for children and families across the region, and the longevity of department personnel, including himself. After three decades at the helm, First continues to give grand rounds at the hospital, mentor faculty and residents, teach medical students, counsel trainees, write and host “First With Kids,” edit Pediatrics, serve on national committees, and speak at educational conferences.

“I am as energized in my 30th year as chair as I was when I arrived in Burlington in 1994. I enjoy what I do and the difference our department and children’s hospital are making,” he says. “My own children and grandchild have grown up needing this children’s hospital, and there’s nothing more reassuring than seeing your kids overcome health issues and become caring members of our community in part because of the great pediatric care they got here over the past 30 years. I want everyone that connects with our department and children’s hospital to feel they are part of a team improving the well-being of children and paving the way for a better future.” VM

“The chance to be creative and at the same time be a scientist, a clinician, a teacher, and a compassionate caregiver is why I chose a career in pediatrics.” – Lewis First, M.D.