The American College of Surgeons (ACS) Leadership & Advocacy Summit exposes surgeons and residents to education and engagement opportunities. Spanning four days, it culminates with a day of visits on Capitol Hill, where attendees can encourage their elected officials to support ACS-based legislation.
The overall experience was empowering. I quickly found myself wanting to share this message to inspire other surgeons to get involved locally and nationally to improve the quality of care our patients receive.
When I first sat down to reflect on my experience, I recalled my first day of medical school at the University of Kentucky, Lexington. During orientation, one of my future mentors, Charles “Chipper” Griffith, MD, MSPH, FACP, professor of medicine and pediatrics, laid out three tenets for success as a physician: inspire confidence, be worthy to serve the suffering, and with great power comes great responsibility.
I think these three points perfectly demonstrate our duties as physicians and encompass the wide scope of responsibility bestowed upon us when we earn that degree. It covers the responsibilities most inherent in the practice of medicine—caring for our patients and their families—but it also lends insight into the greater purpose we can achieve.
As surgeons, we serve as a voice for our patients who do not have our platform. The substantial experience from decades of training and exposure to patients gives us good standing and an opportunity to have a seat at the table. It is important to develop the role as a leader within our hospitals and communities. It is vital to advocate for policies that favor all patients: the healthy through prevention, the sick through treatment, and the downtrodden through access.
In this way, leadership and advocacy tie together perfectly to advance the quality of care we provide.
Defining the surgeon-leader is a difficult task. All surgeons who have been through the rigors of surgical training and have established a practice will wear many hats on their journey. Surgeons are respected role models who can contribute valuable insights on the direction of any organization. In an article by Daniel Goleman, PhD, a science writer, “Leadership that gets results,” six different leadership styles are outlined.1 From my experiences at the summit, and using these six leadership styles, I have created the following list of keys to effective leadership:
- Get involved. Becoming a leader, especially in surgery and medicine, is frequently about showing up and contributing. As you learn the structure and dynamics of an institution or organization, you can start to bring fresh ideas to a body that may be striving to move in a different direction.
- Build up those around you; make them better. Leadership is about building up those around you so that they can achieve their maximum potential.
- Take command when necessary. People like to vilify the “commanding” leadership style for its perceived ineffectiveness; however, there remains a time and a place for it. The classic example is the trauma bay, where a democratic approach may endanger the patient in front of you. Forceful direction also can be helpful in time-sensitive situations and as a calculated motivational tool when team members need a change in attitude.
- Work hard. As surgeons, we choose to be part of a culture of working difficult hours, doing it ourselves, and setting the pace for our team. Serving by example can be effective when used correctly, but dangerous when used to unveil the deficiencies of our team members. Once a leader, don’t be afraid to dip your feet back into the trenches of grunt work for those you supervise. This temporary inconvenience will be rewarded.
- Take input from the team. Valuing team members and employees is essential to maximize the capabilities of what you can accomplish together. Multiple psychological studies have shown that adding meaning to one’s work leads to higher productivity and more buy-in.2-4 It is important to make sure all those on the team are included and valued.
- Have a vision. Ultimately, a strong team and, in parallel, a strong leader must have a unifying vision about where the team will be in the future. A vision can be as simple as having three critically ill patients stay alive after a difficult intensive care shift or as complex as changing the culture of an entire department of surgery. Having the vision is critical, but if you can bring your team members along with you, it is even more powerful.
It is of little surprise that surgeons are underrepresented on Capitol Hill, as many of us do not want to deal with the political machine. It is an environment that often directly contradicts surgical values and can be exceedingly frustrating to confront. However, state and federal regulations and legislation have an enormous impact on how we practice. For this reason, becoming a surgeon advocate is not only recommended—it is essential.
One lesson I learned at the Advocacy portion of the summit is that the ACS Division of Advocacy and Health Policy (DAHP) functions on multiple levels. Specific areas of the division monitor and advocate for state and federal legislation, commenting on regulations issued by government agencies, coding and reimbursement issues, and so on. The College also has a political action committee, the American College of Surgeons Professional Association (ACSPA)-SurgeonsPAC, and a tool to assist surgeon-advocates, SurgeonsVoice. In addition, the division staffs several surgeon-led committees, including the Legislative Committee, the Health Policy and Advocacy Group, and the Health Policy Advisory Committee.
The polarizing political atmosphere in Washington, DC, often leaves little room for common ground on Capitol Hill. And yet, our obligation to get involved remains vitally important. As surgeons, our role in these debates is to defend our patients. For this political purpose, there are few quarrels and little room for debate. After all, and as we often forget these days, we are all on the same side. This realization could go a long way in mending the broken system.
The second lesson from the summit is that our public representatives gravely need our help. Anton J. Gunn, MSW, CDM, 937 Strategy Group, LLC, Johns Island, SC, a leadership speaker and health policy expert who was involved in the development of the Affordable Care Act (ACA), said that he encountered fewer than 20 physicians at major health care legislative meetings in his 20-plus years of service. This statement indicates a dire need for physician involvement in health care reform. Given our insight, physicians must be at the table. It may be even more critical that surgeons be at the table.
The two most high-profile issues in DC are the opioid and firearm violence epidemics. Regardless of one’s political opinion on these issues, the surgeon’s role in reversing these crises is critical. During our congressional visits, attendees were able to discuss these issues in the offices of our senators and representatives.
The opioid epidemic
Opioid overdose deaths continue to increase across the country, and evidence is available to show that postoperative prescriptions, even after minor operations, increase the risk of long-term opioid use.5 Despite the importance of limiting the number of opioid prescriptions to patient need, the procedure-specific amounts have not been well-studied. There are now efforts across the country to quantify this need.6-8 For example, the University of Utah Health system, Salt Lake City, is studying its prescribing practices and the effect on patient satisfaction and disposal practices.9 Nonetheless, health care professionals are dangerously close to allowing our legislators to implement policies that would limit our ability to help our patients. Prescribing limits may prove harmful rather than helpful in the effort to curb the opioid supply. For example, cancer patients, especially in rural areas, would struggle to return every three days to refill their pain prescription.
As noted during the Leadership & Advocacy Summit, legislation should focus on unifying Prescription Drug Monitoring Programs nationally to give physicians standardized information on how best to serve their patients and reduce the red tape that prevents adequate disposal. Given Utah’s spot within the top 10 states for opioid overdoses, our representatives are taking this issue seriously. Sen. Mike Lee (R-UT) is planning an opioid summit in October to discuss this issue with hospital administrators, but physicians need to be involved to ensure important topics within opioid abuse are covered. Rep. Chris Stewart (R-UT) has been involved in negotiations with local law enforcement and the Drug Enforcement Agency to allow for easier opioid disposal at convenient locations. Speaking with these lawmakers about the issues is an important step toward ensuring Congress passes helpful legislation. Based on these discussions, federal legislators are engaged and receptive to advice regarding this crisis.
Firearm injury epidemic
Gun violence is an epidemic that many members of Congress have yet to fully acknowledge. Regardless of political stance, legislators agree that reducing injury secondary to firearms is a priority. Since 1999, firearm-related deaths have increased by 17 percent, and in 2016 an estimated 175 deaths were attributable to firearms every day.10 The ACS recently published a consensus strategy to confront this problem, which provides a framework for overcoming the polarization we have seen over the past several years.11 An essential component for mitigating firearm injury is understanding the underlying causes.
Funding is needed to allow appropriate research to take place. It is important to encourage your representatives to support appropriations of $50 million to study this pressing issue. This amount will be enough to fund 10–20 studies annually to discover the root cause of gun violence in the U.S., while protecting law-abiding citizens’ rights to carry arms.
Emphasis should be placed on the success of public health measures regarding other injury patterns from motor vehicles and bicycles. This success was achieved largely due to Centers for Disease Control and Prevention research identifying areas for prevention. The ACS is conducting focus groups with carrying Fellows to discover ways to reach across the aisle. It is our responsibility to engage public leaders so that firearm injury prevention mirrors the success of other trauma-related public health efforts.
My major takeaway from both the leadership and advocacy portions of the summit is that surgeons must get involved. Without a voice, these concerns will go unaddressed or, perhaps more dangerously, be addressed by inexperienced hands. We would not let our members of Congress perform an inguinal hernia repair on one of our patients, so there is no reason we should allow them to make these decisions—decisions that affect our practice and our patients’ lives—without our input. For a list of other issues that Summit attendees discussed during meetings on Capitol Hill, see the article on page 80.
I also encourage you to take advantage of the College’s advocacy resources to write your state and federal legislators (see sidebar).
This experience has shown me the importance of standing up for these issues and sharing our content expertise during the writing of this legislation. Getting involved in advocacy is a necessary step to serve as content experts and leaders for improving health care within our community and within our country.
- Goleman D. Leadership that gets results. Harvard Business Review Classics. Available at: https://hbr.org/2000/03/leadership-that-gets-results. Accessed June 21, 2018.
- Ariely D, Kamenica E, Prelec D. Man’s search for meaning: The case of Legos. J Econ Behav Organ. 2008;67(3):671-677.
- Chandler D, Kapelner A. Breaking monotony with meaning: Motivation in crowdsourcing markets. J Econ Behav Organ. 2013;90:123-133.
- Norton MI, Mochon D, Ariely D. The IKEA effect: When labor leads to love. J Consum Psych. 2012;22(3):453-460.
- Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in U.S. adults. JAMA Surg. 2017;152(6):e170504.
- Hill MV, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714.
- Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226(6):996-1003.
- The Michigan Opioid Prescribing Engagement Network. Available at: http://michigan-open.org. Accessed May 30, 2018.
- Dr. Sean Stokes on improving opioid prescribing patterns. UHealth Accelerate. Available at: https://uofuhealth.utah.edu/accelerate/blog/2017/08/making-crisis-manageable-sean-stokes-on-improving-opioid-prescribing-patterns.php. Accessed May 30, 2018.
- Centers for Disease Control, Prevention, National Center for Health Statistics. Underlying cause of death, 1999–2016. CDC WONDER Online Database. Released December 2017. Available at: https://wonder.cdc.gov/ucd-icd10.html. Accessed May 30, 2018.
- Stewart RM, Kuhls DA, Rotondo MF, Bulger EM. Freedom with responsibility: A consensus strategy for preventing injury, death, and disability from firearm violence. J Am Coll Surg. April 19, 2018 [Epub ahead of print]. Available at: www.journalacs.org/article/S1072-7515(18)30275-8/fulltext. Accessed May 30, 2018.