2011–2012: A year of reaffirming the College’s past and anticipating the needs of the future

Chairs of the American College of Surgeons’ (ACS) Board of Regents (B/R) serve one-year terms that extend from the end of one Clinical Congress to the end of the succeeding one. My term as Chair of the B/R ended at the close of the 2012 Clinical Congress. During the time that I served in this role, the B/R approved several policies and programs that should serve the organization well, now and in the future.

Whereas the B/R sets the policies for the ACS, it is the ACS staff that ensures these policies are implemented. The B/R spent much of the last year carefully analyzing the structure and function of each division of the College and its role in carrying out the College’s historic mission of improving quality of care and patient access to care through enhanced surgical education. The ACS’ divisions are as follows: Research and Optimal Patient Care, Education, Member Services, Advocacy and Health Policy, and Integrated Communications. Each division offers myriad services designed to benefit the College’s membership and ultimately our patients.

Quality improvement: Inside and out

In keeping with the inauguration of the College’s Centennial year, we felt it appropriate to honor our past emphasis on quality while being forward thinking with regard to future needs of the next decade, if not the next century. Under the leadership of Executive Director David B. Hoyt, MD, FACS, the College has placed renewed emphasis on quality.

During the February 2012 meeting, the B/R closely examined the programs and initiatives carried out through the Division of Research and Optimal Patient Care. As a result of this review, the Regents issued a charge to enhance the ACS National Surgical Quality Improvement Program (ACS NSQIP®) with a goal of substantially increasing its presence in U.S. hospitals.

In addition to ACS NSQIP, the College works to improve quality of care through its extensive verification programs for trauma, cancer, comprehensive breast, and bariatric surgery centers. All of these efforts are growing, and the B/R examined each program in an attempt to ensure they are user-friendly and meeting the needs of both the public and health care providers.

Internally, ACS staff members have been heavily engaged in an internal continuous quality improvement process with a goal of streamlining functions and processes that will permit them to better serve the Fellows. The Division of Member Services, under the leadership of Patricia L. Turner, MD, FACS, has carefully examined its multiple programs with the goal of improving service to patients and Fellows.

It is nearly impossible to summarize all of the quality initiatives under way at the ACS, but suffice it to say the focus has been on doing our jobs better within the organization, as well as outwardly, to better serve patients.

Access to care

This past year, our second major area of concentration was on access to surgical care. For many years, the ACS Health Policy Research Institute (ACS HPRI) has conducted workforce studies through the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, Chapel Hill, under the leadership of ACS Past-President George Sheldon, MD, FACS, and Thomas Ricketts PhD, MPH, Co-Director of the ACS HPRI. These studies have uncovered serious workforce shortages throughout the U.S., and have correlated increases in mortality for several serious health conditions, including trauma, to the lack of access to surgical care.

It became apparent to the B/R that the lack of general surgical care in rural areas was a particularly acute problem. The B/R invited two rural surgeons, ACS Governor Tyler Hughes, MD, FACS, a general surgeon in McPherson, KS, and Phil Caropreso, MD, FACS, a general surgeon in Keokuk, IA, to discuss their issues and needs at the Board’s February 2012 meeting. Following those discussions, the B/R established an Advisory Council for Rural Surgery—the first new Advisory Council created in several decades—to provide a forum for rural surgeons to share their concerns, and to serve as a nexus for political action to enhance access to surgical care in rural areas. (For more information on the discussions of rural surgery issues and the new Advisory Council, see the “Dispatches from rural surgeons” column on page 54 of this issue.)

Surgical education

The ACS Division of Education has continued to advance under the leadership of its Director, Ajit K. Sachdeva, MD, FACS, FRCSC.

During the Board’s June 2012 meeting, the B/R focused on concerns related to the unmet needs in the field of post-residency education. Approximately 80 percent of current general surgery trainees now pursue fellowship training following their residency training; however, there is no correlate training in the area of surgical care in many parts of the country, namely broad-based general surgery. During the meeting, then-ACS Vice-President-Elect, Philip Burns, MD, FACS, outlined concerns regarding whether or not current trainees are adequately prepared to practice. In response, the B/R appointed a special committee to examine the feasibility of accrediting post-residency fellowships in general surgery. If successful, these fellowships, which are envisioned to serve as a transition to practice, would serve to improve quality of care while potentially enhancing access to general surgical care.

As I leave the B/R, it is my fervent hope that my successors will continue to explore opportunities in which the ACS can broaden its involvement with surgical training. I firmly believe that many aspects of our current system of residency training are dysfunctional, if not broken, and that surgeons need to assume more responsibility for the training of future surgeons.

Closing thoughts

In addition to advocating for legislation and policies that will improve quality and access, it is important that the ACS Division of Advocacy and Health Policy, based in Washington, DC, continue to lobby for equitable payment for surgeons. Access to surgical care demands fair compensation for the providers of that care.

It has been a singular honor to have served nine years as an ACS Regent and doubly so to have been elected to serve as Chair this past year. The leadership of the ACS is in good hands from both the standpoint of the officers and the staff as we move toward our second hundred years.

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