While the formal merger between Toronto General Hospital and Toronto Western Hospital officially came into effect in 1986, it was 1988/89 before single leadership positions had been created for all of the surgical divisions in The Toronto Hospital. During the three-year transition period both the Toronto General Division and the Toronto Western Division maintained a Department of Surgery.

Between 1986 and 1988/89, the Department of Surgery at the Toronto General Division consisted of the following 7 divisions: Cardiovascular Surgery, General Surgery, Neurosurgery, Orthopaedics, Plastic Surgery, Thoracic Surgery, and Urology. The Department of Surgery at the Toronto Western Division consisted of the following 6 divisions: Cardiovascular Surgery, General Surgery, Neurosurgery, Orthopaedic Surgery, Plastic Surgery, and Urological Surgery.

In 1988/89 the James Wallace McCutcheon Chair in Surgery was established. The Surgical Directorate, headed by the Surgeon-in-Chief (also known as Vice President Surgical Directorate and James Wallace McCutcheon Chair), was responsible for the administration of the TTH Department of Surgery and various clinical departments including Anaesthesia, Gynecology, and Ophthalmology, as well as the Peter Munk Cardiac Centre and the Neurosciences Priority Program By 1998 the responsibilities of the Vice-President of the Surgical Directorate also included overseeing the departments of Bioethics, Dentistry, ICU, Operating Room-PACU, and Women’s Health. The Surgeon-in-Chief reported to the Executive Vice President and Chief Operating Officer.

The position of McCutcheon Chair, Surgeon-in-Chief and Vice President Surgical Services has been held by Dr. Alan R. Hudson (1989-1991) and Dr. Paul Walker (1992-1999).