The Socioeconomic Issues Committee (SEIC) of the American College of Surgeons (ACS) Board of Governors (B/G) had another busy year. The SEIC has become the largest Governors’ committee, which reflects the broad expanse of socioeconomic factors that affect virtually every aspect of daily surgical practice. Interactions among members at the committee’s annual meeting at the Clinical Congress, and through multiple conference calls throughout the year, clearly reflect the numerous socioeconomic issues that affect the delivery of surgical care in the U.S. and throughout the world.
Humanitarianism and volunteerism
As has been recent practice, the SEIC again had the privilege of reviewing nominations for the ACS/Pfizer Surgical Volunteerism Awards and Surgical Humanitarian Award. The increasing number of candidates for these awards demonstrates the fact that many Fellows are committed to the principles of Operation Giving Back. Their donations of time, talent, and financial support enable programs that bring surgical care and training to patients and health care professionals throughout the world as well as underserved areas of the U.S. The accomplishments of those whom the SEIC selected were described in the September 2012 issue of the Bulletin of the American College of Surgeons;* however, virtually all of the nominees deserve acclaim for their impressive records of selfless dedication to serving where help is needed most.
The inclusion of Robin T. Petroze, MD, a general surgical resident at the University of Virginia, Charlottesville, among the recipients of the 2012 awardees was particularly noteworthy. Dr. Petroze’s work in helping to develop a trauma system in Rwanda demonstrates how residents now have real opportunities to dedicate some of their training time to participation in humanitarian programs and receive appropriate credit from the Accreditation Council on Graduate Medical Education.
Changing practice paradigm
On the domestic front, the SEIC produced a white paper described in last year’s report, which was published in the October 2012 issue of the Bulletin.† Titled Surgical Care and Career Opportunities in a Changing Practice Paradigm, the paper is designed to provide insights and information to the surgeon who is facing a change in practice paradigm, either voluntarily or as the result of the continued amalgamation of clinical care into large, integrated health care delivery systems. Recognizing that these changes in practice affect both the mature surgeon and the finishing trainee, the paper is intended to complement the guidelines regarding hospital employment recently published in the ACS booklet titled Surgeons As Institutional Employees: A Strategic Look at the Dimensions of Surgeons As Employees of Hospitals. Developed by the ACS Division of Advocacy and Health Policy, the brochure was disseminated with the February 2013 issue of the Bulletin.
Surgical Care and Career Opportunities in a Changing Practice Paradigm is currently under peer review for publication in the Journal of the American College of Surgeons and includes a six-part discussion of critical socioeconomic factors that affect many of the processes described in Surgeons As Institutional Employees. The white paper begins with an overview of the characteristics of the changing health care environment, including the impact of health care reform legislation and emerging models of funding for clinical care. The next four sections are designed to assist the surgeon in assessing a prospective employer or partner. These portions of the document focus on identifying critical characteristics that ensure the type of practice or health care organization under consideration will offer professional and personal satisfaction and will allow the surgeon to remain an effective and meaningful advocate for the surgical patient and for optimal quality of care.
The final section of the document addresses the new “product” of surgical practice. In the evolving systems of shared risk and shared reward, surgeons and all acute care providers will find that productivity will be measured based on quality of care provided rather than simply volume of relative value units produced and reported. This new era will require that acute care professionals work with primary care providers to ensure that a population’s chronic diseases are effectively managed so that when acute events do occur, patients are optimally prepared to sustain the acute insult with least potential for deterioration of related or unrelated chronic comorbidities. The acute care provider—among whom the surgical specialist is often most prominent—must, in turn, earn the trust of the primary care practitioner by ensuring that patients requiring surgical intervention receive the highest quality of care.
The mandate is clear: now more than ever surgeons must advocate for optimal quality across the continuum of patient care, define quality in objective terms, and actively lead efforts to evaluate the provision of care to ensure that quality is both optimal and continuously improved. Recognizing that the new paradigm demands a surgical “product” that is as focused on quality assurance as it is on number of surgical interventions, the SEIC offers in this final section a first glimpse at the pathway to the future. Surgeons who remain disengaged from quality improvement efforts will become technical commodities in the professional services cost center of massive integrated health care delivery systems. Those who understand and embrace the full commitment to optimal surgical care will remain the patient’s most important advocate and will guide, if not lead, these emerging systems of care.
The evolving redesign of the B/G will provide current and future Governors with even greater opportunities to focus their talents and time on College activities that will enhance focus and productivity. In so doing, the Governors will become even more effective in their role as the voice and agents of the Fellows.
In light of the many broad issues discussed previously and the ever-changing socioeconomic environment in which Fellows must practice effectively, the committee’s objectives will be redefined to reflect the broad nature of its focus and accomplishments over the past five years. The SEIC will become the Health Policy and Advocacy Workgroup, which resides under the Advocacy pillar of the redesigned B/G—same people, same mission, yet working with more efficiency to continue the same commitment to excellence for surgical care of all of our patients.
Members of the Governors’ Socioeconomic Issues Committee
Joseph J. Tepas III, MD, FACS, Chair
David B. Adams, MD, FACS
David Arbutina, MD, FACS
Linda M. Barney, MD, FACS
Kevin Eugene Behrns, MD, FACS
Michael O. Bernstein, MD, FACS
Bruce J. Brener, MD, FACS
Dale Buchbinder, MD, FACS
Richard J. Buckley, Jr., MD, FACS
Lynn Randolph Buckner, MD, FACS
David Felix Canal, MD, FACS
David W. Cloyd, MD, FACS
Walter C. Dandridge, Jr., MD
Anthony D. Dippolito, MD, MBA, FACS
Mary E. Fallat, MD, FACS
Tyler G. Hughes, MD, FACS
James L. Kessler, MD, FACS
Deborah Susan Loeff, MD, FACS
Nipun B. Merchant, MD, FACS
Mark William Moritz, MD, FACS
Susan L. Orloff, MD, FACS
James Aloysius Reilly, Jr., MD, FACS
Chad A. Rubin, MD, FACS
Robert C. Shamberger, MD, FACS
Mika N. Sinanan, MD, PhD, FACS
Howard Lawrence Sussman, MD, FACS
Nicholas Blair Vedder, MD, FACS
Matthew J. Wall, Jr., MD, FACS
Lewis Wetstein, MD, FACS
Adnan Ali Alseidi, MD, FACS
James Clinton Denneny III, MD, FACS
Elan R. Witkowski, MD
Robert R. Bahnson, MD, FACS
Kathleen M. Casey, MD, FACS
Charles D. Mabry, MD, FACS
John G. Meara, MD, FACS
Andrew L. Warshaw, MD, FACS
John Chingswei Chen, MD, FACS
Jamie Kazay, ACS Division of Member Services
*Casey K, Kodera A. Fellows honored for volunteerism. Bull Am Coll Surg. 2012;97(9):74-76.
†Vickers, SM. Governors’ Committee on Socioeconomic Issues. Bull Am Coll Surg. 2012;97(10):51-56.