Remembering Dr. Ronald D. Miller

We are sad to announce that Dr. Ronald D. Miller passed away on February 27, 2025. He served as chair of the UCSF Department of Anesthesia and Perioperative Care from 1984 until 2009, and was one of the most successful physician-scientist-leaders in the field’s history.

Born and raised in South Bend, Indiana, Miller earned both his undergraduate and medical degrees from Indiana University. He played piano and horn to support himself throughout those years. A self-professed hater of snow, he moved to southern California to complete his internship at Riverside County Hospital.

Miller recalled that when he arrived in San Francisco in 1964 to interview for a position in the UCSF Anesthesia Residency he didn’t know much about the department, except that its chair, Stuart C. Cullen, MD, had authored a well-regarded, albeit small, anesthesia textbook. While visiting, he remembered witnessing a junior faculty member respectfully challenge Cullen during a department meeting. Impressed by this atmosphere of open thinking, Miller entered the UCSF Anesthesia Residency in 1965, graduating in 1967 before completing a fellowship in pharmacology in 1968.

During his residency, Miller learned he would be drafted to serve in the Vietnam War. A pragmatic thinker, he realized he should enlist. Shortly thereafter, he flew to Washington, DC, to speak with a Naval recruiter. As a result, Miller was stationed at the Naval Hospital in Da Nang, where he would perform his seminal work on massive blood transfusions, for which he received a Bronze Star with a Combat V for meritorious service.

After returning from Vietnam, Miller began his influential work monitoring neuromuscular function in study patients given isoflurane. From there, his investigations into the interaction of volatile anesthetics and muscle relaxants evolved, and over the next 30 years, he and the many talented residents and colleagues he would attract played a central role in understanding the pharmacokinetics and dynamics of muscle relaxants and their antagonists.

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In 1984, after an international search, Miller succeeded William K. Hamilton, MD, as the UCSF Anesthesia Department Chair, a position he would hold for the next 25 years, seeing the department through enormous growth and its joyous 50th anniversary celebration. During his tenure, Miller implemented a broad and strategic approach, cementing the department’s status at the forefront of the profession. He called for an outside evaluation of the department’s research program to ensure UCSF would stay ahead of the curve. Serving as president of the UCSF Medical Staff, he aligned the department with the hospital’s goals and built on the strong and respectful working relationship with surgery that his predecessor Dr. Hamilton had established. Miller also oversaw a complete revamping of the department’s finances, developing rigorous systems for professional fee billing that are still in place today.

He was tirelessly responsive to external change. As more anesthesia sub-specialties emerged, in the tradition of his predecessors Miller continued to recruit the best faculty and fellows in the world to establish those sub-specialties at UCSF. As changes in health care financing and delivery fostered changes in hospital stays, Miller created a nationally recognized multidisciplinary outpatient pain clinic and an inpatient pain service, both of which helped establish UCSF as a leader in pain treatment and anesthesia as the go-to specialty for pain. He continued to expand anesthesia’s leadership in intensive care at UCSF – a role pioneered by his two predecessors as chair.

Miller’s authorship of the most widely used textbook for anesthesia in the world (Miller’s Anesthesia) has highlighted UCSF faculty and dramatically enhanced our department’s international reputation. He established a translational research fellowship while recruiting leading investigators to our faculty to ensure we grew a research portfolio that reached across specialties and around the world. Even when there were brief downturns in the number of applicants for anesthesia residencies nationwide, under Miller’s leadership, UCSF Anesthesia and Perioperative Care continued to attract the best, and the brightest.

The Pursuit of Excellence – the title of Dr. Miller’s 2009 Rovenstine Lecture to the ASA – was the lodestar of Dr. Miller’s career, a highlight of which was his election to the Institute of Medicine at the National Academy of Sciences in 1998. His research contribution began with the historic clinical research he initiated in a combat hospital during the Vietnam War – work that changed the way hospitals treat coagulopathies associated with massive blood transfusion. It continued with his seminal work on the safe use of neuromuscular blockade, and his serving on several NIH study sections, including being chairperson of the NIH Surgery, Anesthesia, and Trauma Study Section and as editor in chief of Anesthesia and Analgesia. Dr. Miller’s many contributions to medicine and patient safety honor a history that included the research discoveries of John Severinghaus, Ted Eger, and Dr. Miller’s classmate, George Gregory.

As Dr. Miller once said, “It’s still of prime importance to think big and dream.” Please join us in honoring his memory, service, and vision.

There will be a celebration of his life scheduled at a later date.

*Photo credit: Richard Schlobohm and Christine Jegan