Cleveland native Smith played football in college and went on to a postgraduate program in biophysics. He dropped out and wound up working as a telephone lineman in Vermont for a year, before applying to medical school at Case Western Reserve. In 1982, he joined Columbia as a cardiothoracic surgery resident and became associate director of the Columbia-Presbyterian Heart Transplant Program two years later. He was named chief of the cardiothoracic department in 1996 and interim chair of the hospital's department of surgery in 2007.
On Smith's watch, New York-Presbyterian's cardiothoracic surgery department has become known as one of the best in the city; it now performs more than 1,500 open-heart procedures a year. (Smith himself, a busy man, performs 350.) Smith has pioneered less invasive heart surgery techniques using lasers, and was part of a team that invented a coronary bypass technique using a tiny camera that doesn't require doctors to cut open the chest. In recent years, he's gone to great lengths to expand the department. In 2004, New York–Presbyterian poached Dr. Jeffrey Moses, the head of the interventional-cardiology department at Lenox Hill Hospital, who arrived with his entire team in tow; Moses is one of the leading practitioners of angioplasties and stent insertions. Other doctors on the team include Dr. Eric Rose and Dr. Mehmet Oz, who spends more of his time on TV than in the OR.
Smith's success running the department have helped New York–Presbyterian reel in a number of big donations. The hospital is now constructing the Milstein Family Heart Center, which is expected to be one of the most comprehensive heart facilities in the world. Named in honor of Seymour Milstein, the brother of Paul Milstein, the $250 million, 142,000-square-foot facility is scheduled to open in 2009.
It was Smith who performed a successful quadruple bypass procedure on Bill Clinton in 2004. Interestingly, Smith wasn't the first person asked to perform the surgery. Dr. O. Wayne Isom at Cornell was initially called about a "VIP patient" while he was at his house in East Hampton. When the caller wouldn't tell Isom who the VIP was, he decided to pass so he wouldn't miss his 9 a.m. tee time. He recommended that Smith be contacted instead.
Smith has been married to Trish, a lawyer, for more than 30 years. They have two daughters, Elizabeth and Halley, who were both athletes at dad's alma mater Williams College. The Smiths paid $3.25 million for a home in Bronxville in 2006. They also have a summer home in upstate New York.