Proving the Naysayers Wrong: Trailblazing Thoracic Surgeon Dr. John Howington Shows Grace Under Fire

When someone is a cardiothoracic surgeon, has authored publications, held leadership and teaching roles, presented internationally, been listed in "Best Doctors in America," trail-blazed cancer prevention and treatment, and helped raise a family, you might think that person grew up surrounded by degrees and overflowing with confidence.

"Kind of the opposite," says John Howington, MD, a University of Tennessee Health Science Center alumnus and practicing thoracic surgeon at Virginia Mason Franciscan Health, St. Michael Medical Center in Silverdale, Washington.

Shaped by Service

Dr. Howington grew up in the Nashville area, the youngest of eight. His father served in World War II in a submarine, later suffering from post-traumatic stress disorder and alcoholism. Attributes common to these illnesses led to his parents' divorce before his fifth birthday. His mother rejoined the workforce after 20 years.

"She was my first example of servant leadership," he says. "No one worked harder. She provided a loving home and a spirit of kindness to others."

When he was in second grade, the school participated in a research project involving IQ testing. His mother got called to the school, and she thought it must be something mischievous like with her older boys. Instead, she learned her youngest is gifted.

"So from that point forward, her expectations of my scholastic achievement were much higher," he says.

Breaking the Mold

His father was a pipefitter. His uncles were plumbers. His grandfather was a plumber. No male in his generation had finished college. But he kept working hard, learning from his community at church and teachers how to care, apply yourself, and not focus solely on good grades but mastering a subject and achieving.

People started asking him what he wanted to be. He said a doctor, with no real reference other than TV, or when he was little and had seen his sister's newborn baby in the hospital.

"Because of my background, a lot of people told me, 'You're a Howington, you aren't meant for college. You're not smart enough. You should think about trade school.' But my mother believed in me. My siblings believed in me. And my friends and their parents believed in me. It was that love and support that carried me through my darkest hours of self-doubt."

As to the naysayers, Dr. Howington says they became a driver, and he wanted to prove them wrong. He earned his undergraduate degree from Tennessee Technological University, where he met lifelong friend Max Moss the fall of freshman year. They became fraternity brothers and later medical school roommates in Memphis.

Family in Medicine

Max Moss, MD, is a UT Health Sciences alumnus and diagnostic radiologist in Murfreesboro with Ascension Saint Thomas Rutherfurd Hospital. Dr. Moss says their careers crossed professionally when they served together on a key lung cancer committee, where he saw firsthand Dr. Howington's leadership capabilities.

Additionally, Dr. Moss' son was in his first year of college when he acquired a life-threatening pulmonary complication.

"It was John who we trusted to operate and bring him back to good health," Dr. Moss says.

When he completed medical school, Dr. Howington began seeing more patients and starting a family. Medicine became a way to help people, earn a living, and be a better man for his children, he says. He admits though he's not extremely competitive, his fellow students and colleagues drove him to improve and never remain stagnant. Surgery appealed to him and was "invigorating; they were the sickest patients."

A Niche Calling

Researching what surgical specialty to pursue, he learned there were too few thoracic surgeons in America, and he found that unmet need to be a calling. However, he heard from the naysayers again. How a different surgical specialty could make 50% more money. He didn't care, he knew what he wanted to do.

Dr. Howington matched at Vanderbilt University for a thoracic residency. A couple years after finishing, he was recruited to be a division chief at the University of Cincinnati.

There, just like other parts of the country, they were starved for a thoracic surgeon. With Dr. Howington, they built a team, a training program, and widened the specialty's leadership, as well as pioneered minimally invasive thoracic surgery.

In the past, if you had an operation on your lungs, Dr. Howington says they would make a large incision and open your chest like a mechanic opens a car hood. So they sought additional training and learned how to do it with small incisions and a scope.

"I couldn't stand having patients come back to the office, not able to stand up straight from the pain of the operation. That minimally-invasive approach allowed them to have more normal function sooner. It reduced complications."

Dr. Howington and his team taught others, those already practicing and residents. He says it was hard work but the focus was on the patient. The less-invasive operation initially paid less, and people brought that up. Yet that didn't deter the focus.

Throughout my career, I've always felt like you can accomplish more as a group.

Because of his efforts and following exposure, he was recruited to Chicago to lead thoracic surgery. He was able to amplify his impact further through a large hospital system, its leadership, guidelines, tools, and a process that echoed through physicians to tens of thousands of patients.

Taking On Tennessee's Lung Cancer Crisis

The American Cancer Society states lung cancer is the second most common cancer in the United States, and the leading cause of cancer death. Each year, more people die of lung cancer than colon, breast, and prostate cancers combined. Women and Black men are also more likely to develop it.

When Dr. Howington's hometown called - and plenty of people would call him over the years - he knew Tennessee was in the top three for lung cancer death rates. (It's not in the top anymore, he says.) He knew there was a need including a focus on the underserved.

Like the rest of America, fewer than 10% of people were getting screened, and screening would reduce their risk of dying by 40%, Dr. Howington says. When he joined Saint Thomas Health in Nashville, the group was doing less than 15 screenings a week. He put that into perspective, saying that's like a woman getting a mammogram and being one of only two or three patients that day. The team raised those screenings by over a hundred screenings a week.

They also worked to gain private and public funding to take mobile CTs into rural counties, changing lives free of charge.

From Nashville Streets to National Leader

Moreover, just last summer, the Supreme Court ruled to affirm that preventative services recommended by the U.S. Preventative Services Task Force, including lung cancer screening, must continue to be covered by most insurance plans at no cost to patients. Dr. Howington working with the American College of Chest Physicians was part of that group effort.

He's continuing to work to increase screenings everywhere in the same way individuals get mammograms and colonoscopies. They've already stage-shifted lung cancer, which aids survivability, and are continuing to develop newer, targeted therapies to improve overall lung cancer survival.

Most recently, Dr. Howington received his Physician Executive MBA from the University of Tennessee, Knoxville. He had heard it was a well-regarded program, and he liked that it was tailored to physicians. Dr. Howington is also presently serving as president of the American College of Chest Physicians.

"Throughout my career, I've always felt like you can accomplish more as a group," he says, and he feels humbled to be recognized among his peers with a recent UT Health Sciences Outstanding Alumni Award.

Immersive Training Elevates Students

"The UT College of Medicine gives you an outstanding clinical experience," he says. "In your third and fourth year, you're fully engaged in the care of patients. You're there at the bedside. You're scrubbed in the operating room. It was a hands-on, immersive experience."

He gives examples of being able to do incisions, place chest tubes, and resuscitate. When he showed up as an intern later in general surgery, he had a head start on his peers, and that gave him an opportunity to do more in the operating room than his peers, he says.

"It gave me the confidence that I had the skillset to be successful. It was the foundation for thinking I could do something beyond general surgery training, and entertaining doing cardiac and thoracic surgery."

From brilliant surgeon mentors to instilling a desire to give back to academia and stay connected to the advancement of the profession and each other, Dr. Howington says those things helped him learn how to accomplish more for patients, based in science, even in challenging times.

When Dr. Howington and his wife moved to Washington as empty-nesters wanting to enjoy the mountains, he left Tennessee with more thoracic surgeons than ever. All good people, all doing good work, he says.

"I am proud to be an alumnus of UT Health Science Center, and I look forward to continuing to contribute to its legacy … And I wasn't supposed to be here. I was that poor kid, walking the streets of Nashville, a pipe-fitter's kid."

This story was initially published in the winter 2026 issue of Medicine Magazine.