Surgeons lead in many different ways. Surgeons lead in the operating room (OR), heading a team of practitioners caring for a single patient who has put his or her well-being in their hands. Surgeons lead on rounds, heading a clinical team responsible for the day-to-day progress of a patient’s surgical care. Surgeons lead by educating their colleagues, fellows, residents, medical students, and affiliated practitioners about the clinical and technical aspects of the art and science of surgery. Surgeons lead by conducting research with widespread implications for surgical diseases and quality of care in surgery. Surgeons lead by serving in key roles for their institutional, loco-regional, and national organizations and committees. Surgeons lead by being the voice for the house of surgery to state and federal legislators. And notably, surgeons lead by mentoring the future generation of surgical leaders. The Resident and Associate Society of the American College of Surgeons (RAS-ACS) is the home of that future generation of surgical leaders.
As a junior surgical resident, I was aware of the ACS and knew that the faculty at my residency who were my leaders on rounds, in the OR, and in the research laboratories proudly acknowledged their Fellowship in the College, along with their other professional credentials. The latter represented years of hard work and ambition toward a degree, and the former represented the dedication to quality patient care, technical innovation, and continuous professional development in the field of surgery—a process that starts when one becomes a surgical intern and lasts throughout one’s surgical career. However, I was unaware of how to embrace that process and how to become a surgical leader until I became active in the RAS.
Mentorship and future leaders
I was fortunate early in my career to have a mentor who introduced me to several key leaders within the College, including Thomas R. Russell, MD, FACS, former Executive Director; Ajit K. Sachdeva, MD, FACS, FRCSC, Director of the Division of Education; and R. Scott Jones, MD, FACS, former President and the first Director of the Division of Research and Optimal Patient Care. Through the professional relationships that I developed with these leaders, I was able to provide the perspective of young surgeons on a number of important surgical issues ranging from the quality of bariatric surgery to the growing trend of surgical health services research.
At a later point in my career, Danielle Katz, MD, FACS, encouraged me to become actively involved in one of the four standing committees of the RAS, which quickly led to roles on the RAS Communications Committee, the College’s Women in Surgery Committee, the RAS Web portal, the Advisory Council on General Surgery, and now the RAS Executive Board. These experiences have provided me with opportunities for professional development, networking, and leadership training far beyond the resources available in any of my training programs. I firmly believe that these experiences in the RAS have improved my ability to lead as a clinician, an educator, a researcher, and as a member of society who is interested in improving access to quality surgical care. The greatest and most challenging of these experiences has been serving as Chair of the RAS this year.
Past Chairs’ experiences
Rather than focus on my own experiences as RAS Chair, however, I have taken this opportunity to explore how those who have preceded me as leaders of this organization over the last decade were shaped as leaders as a result of their early engagement in the College through the RAS. The nine previous Chairs of the RAS from 2002 to 2011 were contacted via e-mail and asked to describe how their experiences as RAS Chairs have shaped them as professionals. Responses were analyzed using standard qualitative methods with NVivo software.
All nine past RAS Chairs responded to the query. Qualitative analysis of their responses revealed seven consistent themes, which are italicized in the following text. Their comments, some of which are highlighted below, and their current roles richly describe the many ways in which surgeons also serve as leaders.
Respondents found that they gained both specific leadership skills (5/9) as well as insight into the workings of complex organizations (7/9) and the issues facing the surgical profession (3/9) as a result of their experiences as RAS Chair. Dr. Katz noted, “Understanding an organization, its position in a greater context, and having some element of ‘institutional memory’ are critical for providing successful leadership.” Joshua M.V. Mammen, MD, FACS, responded that he “gain[ed] a perspective into the complex decisions that have to be made in leadership positions…[and learned to] anticipate barriers to change and to maneuver through obstacles that may be present.” Jeffrey Upperman, MD, FACS, said, “RAS prepared me for working in a large organization with competing demands and learning to work within an organizational framework to reach important goals and objectives.” According to Michael Sutherland, MD, FACS, he learned that leaders succeed, in part, by delegating to “hard workers who will bring their energy and expertise to a project or a committee.” Dr. Katz echoed this sentiment, stating, “Personally, during that year as Chair I learned that I could hold a position of leadership, but also that, as a leader, I needed to rely on those around me. Surrounding oneself with talent seems to me to be a remarkably helpful aspect of being an effective leader.” Among the difficult and complicated issues facing the College and the profession of surgery that respondents were able to understand better and even address during their tenure were changes in surgical education, health care initiatives, economics, and advocacy, as well as credentialing, and family leave policies.
Beyond skills and issues, however, the ability to represent and network with one’s peers in surgical training (2/9 and 8/9 respectively) was a common theme among respondents. Willie Underwood III, MD, MPH, was one of the early chairs of the RAS when it was evolving from its prior iteration as the Candidates and Associates Society. He noted, “We were excited—we wanted to make a difference, to have our voices heard. At the time, surgical training was under attack, and there was no venue for the surgical residents to express their opinions in an organized forum.” Dr. Mammen stated, “I had the privilege to communicate the opinions of my colleagues to the leadership of the American College of Surgeons.”
Networking with peers was, however, a more powerful theme. For Joshua Broghammer, MD, FACS, this was “the most important aspect” of his experience as RAS Chair. He commented that he made numerous contacts “from around the country with various backgrounds and specialties, which creates an incredible network of resources which I can call on from time to time and will continue to do so in the future.” Gregory S. Cherr, MD, RVT, FACS, cited a “network of friends and colleagues who provide me with support and advice in my professional and personal life” as an important component of the Chair experience.
The ability to find role-models and mentors (8/9) among leaders of the College was also a resounding theme among respondents, and yielded the richest commentary. “The inherent mentorship that is built into the three-year progression from Secretary to Vice-Chair to Chair was crucial to my development,” Dr. Moalem said. “By the point that I became Chair, I had numerous mentors and friends among ex-officio Chairs of RAS, and among the Regents and Governors of the College.”
“I also had the opportunity to see the leaders of the College at work in the Board of Regents and some of the ACS committees and tried to understand what qualities made these well-established leaders as successful as they were,” noted Dr. Katz. Echoing these observations, Dr. Mammon responded, “I was able to meet many of the thought leaders in surgery and thereby gain a perspective into the complex decisions that have to be made in leadership positions.”
Some respondents cited specific benefits of mentorship. For example, Dr. Broghammer noted, “Through my interactions with senior urologists on the Board of Regents I have developed relationships that have helped promote me within my subspecialty organization, the American Urological Association.” Dr. Cherr was able to meet “many outstanding medical educators who helped me to understand that it is possible to have a successful academic career in surgical education.” Finally, Dr. Sutherland directly credits his exposure “to the leaders of the College” as the reason for his current position and stated, “Dr. [Charles] Mabry [MD, FACS], my partner and a former Regent of the College, recruited me to Arkansas during my time as the Chair of RAS.”
Not surprisingly, respondents found that their experiences as RAS Chair served as a foundation for their future successes (4/9). Many of these successes are listed in the table. Dr. Upperman summed it up well: “I also learned an incredible amount from the ACS leadership on how surgeons are relevant to health in America.”
The last decade of RAS Chairs
|2002–2003||Willie Underwood III, MD, MPH||Dr. Underwood is associate professor of surgical oncology, department of urology, Roswell Park Cancer Institute, Buffalo, NY. His career consists of delivering clinical care in urologic oncology, performing health service research, and contributing to health policy. His research focuses on understanding health system-related and societal factors that affect health outcomes and examines racial and socioeconomic differences in cancer knowledge, early detection, treatment, and survival. Dr. Underwood has also evaluated the impact of health policy changes in residency training on health care quality. His research reflects a commitment to improving the health and health care of Americans in general, and of the poor and disenfranchised more specifically.|
|2003–2004||Jeffrey Upperman, MD, FACS||Dr. Upperman is currently associate professor of surgery at the University of Southern California, Los Angeles, and the director of trauma at Children’s Hospital Los Angeles.|
|2004–2005||Danielle A. Katz, MD, FACS||Dr. Katz is associate professor of orthopaedic surgery at the State University of New York Upstate Medical University, Syracuse. She specializes in pediatric orthopaedic surgery and is the assistant program director for the residency program in orthopaedic surgery. She serves on a number of committees within her institution, including the clinical quality improvement committee and the institutional review board. Dr. Katz is currently the Secretary of the New York Chapter and a member of the Governing Council of the Young Fellows Association.|
|2005–2006||Michael Sutherland, MD, FACS||Dr. Sutherland is assistant professor of surgery at the University of Arkansas for Medical Sciences and is in private practice in Pine Bluff, AR. He is a general, trauma, and vascular surgeon with an interest in surgical critical care. He is the chair of the Arkansas Trauma Education and Research Foundation and is actively involved in the development of the statewide Arkansas Trauma System. He currently serves on the General Surgery Coding and Reimbursement Committee of the College and is on the Society for Vascular Surgery Health Policy Committee. He participates at the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) and is a member of the ACSPA-SurgeonsPAC Board of Directors.|
|2006–2007||Gregory S. Cherr, MD, RVT, FACS||Dr. Cherr is chief of vascular surgery, Buffalo General Hospital, NY, as well as associate professor of surgery with tenure and research associate professor of social and preventive medicine at the University at Buffalo, NY. He also serves as director, medical student programs, in the department of surgery.|
|2007–2008||Ted James, MD, FACS||Dr. James is a surgical oncologist and associate professor of surgery at the University of Vermont College of Medicine where he serves as clerkship director for surgery. He is active in quality and outcomes research in cancer care delivery as well as translational research in oncology.|
|2008–2009||Jacob Moalem, MD, FACS||Dr. Moalem is assistant professor of endocrine surgery and of endocrinology at the University of Rochester, NY. He currently serves as Chair of the Young Physicians’ Surgical Caucus at the AMA, and is also on the Executive Board of the ACS Young Fellows Association and the Board of Directors of the ACSPA-SurgeonsPAC. He is a delegate for the ACS at the AMA. He runs a practice in endocrine surgery and he conducts ongoing research in endocrine surgery and surgical education.|
|2009–2010||Joshua Broghammer, MD, FACS||Dr. Broghammer is assistant professor of urology at the University of Kansas Medical Center, Kansas City, where he focuses on trauma and male genitourinary reconstruction. He is passionate about resident education and studies the management of renal injuries, post-prostatectomy complications, and the treatment of urethral stricture disease. He is also a member of the ACS Legislative Committee.|
|2010–2011||Joshua M. V. Mammen, MD, FACS||Dr. Mammen is an assistant professor of surgery and molecular and integrative physiology at the University of Kansas, Kansas City. He also serves as the associate program director of the surgery residency program. He is a surgical oncologist with a focus on melanoma, sarcoma, breast cancer, colorectal cancer, and peritoneal surface malignancies. His basic science laboratory focuses on the use of natural compound derivatives in the treatment of melanoma.|
|2011–2012||Heena P. Santry, MD, MS||Dr. Santry is assistant professor of surgery and quantitative health sciences at the University of Massachusetts Medical School. She is an acute care surgeon and health services researcher whose work focuses on quality and outcomes for unexpected surgical emergencies. In addition to her work in the RAS-ACS, she is active in the College’s Women in Surgery Committee.|
*As described by the past Chairs with minor editing for tense and style.
As the current Chair of the RAS, it is my privilege to introduce this special issue of the Bulletin and to reflect on what it means to be a leader as learned through participation in the RAS. The following four articles, written by RAS members, will delve into the many manifestations of surgical leadership. Readers will learn about the historical underpinnings of surgical leadership, the cardinal traits of effective leaders in surgery, and the ways in which every member of the College can take the opportunity to lead both within the organization and in myriad other arenas that shape the delivery of surgical care. I hope this informative and engaging issue will inspire you to encourage and promote the young surgeons around you to embrace a path to leadership within our profession.