The Bulletin » ACS Board of Governors’ committee updates http://bulletin.facs.org by the American College of Surgeons Mon, 03 Nov 2014 17:00:12 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.2 Governors’ Committee on Physician Competency and Health http://bulletin.facs.org/2013/05/physician-competency-and-health/ http://bulletin.facs.org/2013/05/physician-competency-and-health/#comments Wed, 01 May 2013 05:52:34 +0000 http://bulletin.facs.org/?p=5448 Being Well and Staying Competent: Challenges for the Surgeon, which is available on the ACS members-only portal at www.efacs.org.]]>

Members of the Governors’ Committee on Physician Competency and Health

  • Roger R. Perry, MD, FACS, Chair
  • Michael P. Vezeridis, MD, FACS, Vice-Chair
  • James A. Anders, MD, FACS
  • Jeffrey O. Anglen, MD, FACS
  • Gerald J. Bechamps, MD, FACS
  • Karen Jean Brasel, MD, FACS
  • Adam Deutchman, MD, FACS
  • Clifford W. Deveney, MD, FACS
  • Christian Miguel deVirgilio, MD, FACS
  • Richard E. Fine, MD, FACS
  • James W. Fleshman, Jr., MD, FACS
  • Daniel J. Frey, MD, FACS
  • Nelson H. Goldberg, MD, FACS
  • Dinakar Golla, MD, FACS
  • Michael T. Jaklitsch, MD, FACS
  • Lynne M. Jalovec, MD, FACS
  • Gerald H. Jordan, MD, FACS
  • Krista L. Kaups, MD, FACS
  • Scott Henry Kurtzman, MD, FACS
  • Lorrie A. Langdale, MD, FACS
  • Warren E. Lichliter, MD, FACS
  • Ernest E. Moore, MD, FACS
  • Michael Robert Oreskovich, MD, FACS
  • Brian Joseph Santin, MD
  • Hugh E. Scully, MD, FACS
  • Tait Shanafelt, MD
  • Edwin W. Shearburn III, MD, FACS
  • Ralph W. Stewart, MD, FACS

The Board of Governors’ (B/G) Committee on Physician Competency and Health serves the following purposes: (1) examine issues related to surgical competency, emphasizing credentialing and practice within expected community standards; and (2) promote maintenance of physical and mental wellness among Fellows of the American College of Surgeons (ACS). Thanks to the hard work of the members of the committee and outstanding leadership provided by previous Chairs, most recently Krista L. Kaups, MD, FACS, the committee has continued to address issues that affect every surgeon.

In the past, little data were available to indicate how stressors affect surgical practice. However, recent data have shown that none of us is immune to the effects of stress and the potential for burnout. The increasing demands of surgical practice—including more elderly patients with complex surgical problems, rapidly evolving technology, long hours, fewer surgeons available to take emergency room call, declining resources and reimbursements, and the decline in the general public’s overall view of the medical profession—contribute to stress. The current uncertainty about the direction of the entire health care system and the role that surgeons will play in the future are also factors to consider in maintaining mental wellness.

Member surveys

To help gather data on the current levels of stress among surgeons, the first survey of Fellows, spearheaded by Gerald Bechamps, MD, FACS, with the support of the College, was conducted in 2008. The survey was developed with the assistance of Tait Shanafelt, MD, and other physicians at the Mayo Clinic, Rochester, MN. A total of 7,905 fellows responded to the anonymous electronic survey. The results were startling. Among the most significant findings was a 40 percent rate of burnout among the respondents.1 Burnout is a syndrome characterized by emotional exhaustion and depersonalization (or cynicism) in relationships with colleagues or patients and accompanied by a sense of inadequacy or reduced personal accomplishment. Surgeon burnout was associated with specialty choice (highest odds ratios in trauma, urology, otolaryngology, and vascular surgery), having children younger than age 21, number of hours worked per week, number of nights on call, and compensation based entirely on billings. Hours worked and number of nights on call increased the risk of burnout in both academic and private practice surgeons. Also of concern, nearly one-third of respondents screened positive for depression and 6 percent exhibited suicidal ideation.

Another survey of the Fellows was completed in 2010 with support of the College. Nearly 7,000 Fellows responded to this survey, which addressed interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. The data showed that alcohol is by far the most widely used or abused substance.2 The rate of alcohol abuse or dependence was 15 percent among the entire group, which exceeds the rate in the general population. The rate for male surgeons was 14 percent and for female surgeons it was 25 percent. Not surprisingly, a strong association between alcohol abuse or dependence and burnout was noted. On a positive note, however, the literature has shown that surgeons who suffer from substance abuse have high rates of recovery if they participate in a structured program and agree to long-term supervised monitoring. These surgeons generally are able to return to active practice.

A new 2013 survey is due to be distributed shortly to the ACS membership, again funded through the generosity of the College. Dr. Shanafelt and his colleagues at the Mayo Clinic have again assisted in the development of the survey. This new survey differs from prior surveys in that the goal is to determine how accurately surgeons are able to assess their level of well-being and distress in comparison with their peers. The hypothesis is that physicians, and surgeons in particular, are not very good at making this assessment. Indeed, most physicians and surgeons are unable to recognize that they need help or to make changes until a crisis occurs. This survey includes a self-assessment tool that will allow surgeons to compare their distress levels and level of well-being with a national sample of 7,000 physicians. Electronic follow-up contact will occur three to four weeks after the initial survey to see if participants have made any changes or plan to make changes based on their self-assessment. This trial will be the first conducted by the ACS, and one of the few trials to evaluate whether an electronic resource can help effect positive change.

Being well and staying competent: Challenges for the surgeon

  • Introduction
  • Physician personalities, stress, and burnout
  • Substance abuse
  • Sleep deprivation
  • Boundary issues
  • Age impairment
  • The disruptive surgeon
  • Credentialing issues
  • Summary statements
  • Resources

Physician health document

The committee developed a booklet on the impaired surgeon in 1992, which was subsequently revised in 1995. Updating and revising the booklet to reflect new challenges facing surgeons today has been a major focus of the committee. Thanks to the hard work and strong leadership of Dr. Kaups, this new document, titled Being Well and Staying Competent: Challenges for the Surgeon, has recently been completed. This document is a complete rewrite and involved many hours of work by dedicated committee members, including conference calls and face-to-face meetings. This updated version is timely and addresses important physical and mental wellness topics and offers links to self-assessment tools and other online resources (see sidebar at the top of this page). Currently, Being Well and Staying Competent is available online in its entirety through the ACS Members-only portal at www.efacs.org. In addition, the Bulletin will periodically publish excerpts from the document, beginning with next month’s issue.

Looking ahead

The prior surveys are the source of, or have at least been cited in, a large number of publications, articles, and other documents (see bibliography), and several more are in development. Currently under examination are comparisons between rural and urban surgeons with respect to stressors and burnout level, and plans are being discussed to develop surveys for international Fellows. The issue of aging and competency is coming to the forefront. It is anticipated that this complex and difficult issue will necessarily be a major focus of the committee over the next few years. The new 2013 survey of the Fellows will need to be completed; the data will then be analyzed, and compared with findings from the two previous surveys. Thus far, the committee has depended on the generosity of the College for financial support. A stable funding source and mechanism will need to be developed so that the important efforts and productivity of the committee may continue.

Acknowledgments

It is important to note that the committee’s accomplishments to date are largely due to the hard work of each of the committee members, especially Dr. Kaups and Mick Oreskovich, MD, FACS. The author also acknowledges the major contributions of other prior committee members and past-chairs including Kenneth Sharp, MD, FACS; Dr. Bechamps; and John Hanks, MD, FACS.
Finally, Dr. Shanafelt and his colleagues at the Mayo Clinic must be recognized for their outstanding help with developing the surveys and analyzing the data.


Bibliography

  1. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag JA. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
  2. Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, Meredith C, Buhl A, Dyrbye LN, Shanafelt TD. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168-174.
  3. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag J. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.
  4. Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: Understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371-376.
  5. Kuerer HM, Breslin T, Shanafelt TD, Baile WF, Crawford W, Balch CM. Roadmap for maintaining career satisfaction and balance in surgical oncology. J Am Coll Surg. 2008;207(3):435-442.
  6. Dyrbre LN, Shanafelt TD, Balch DM, Satele D, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg. 2011;146(2):211-217.
  7. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318-1321.
  8. Balch CM, Shanafelt TD. The dynamic tension between success in a surgical career and personal wellness: How can we succeed in a stressful environment and a “culture of bravado?” Ann Surg Oncol. 2011;18(5):1213-1216.
  9. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Freischlag J. Physicians married or partnered to physicians: A comparative study in the American College of Surgeons. J Am Coll Surg. 2010;211(5):663-671.
  10. Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, Freischlag JA. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg. 2010;211(5):609-619.
  11. Balch CM, Shanafelt TD, Sloan J, Satele D, Kuerer HM. Burnout and career satisfaction among surgical oncologists compared with other surgical specialties. Ann Surg Oncol. 2010;18(1):16-25.
  12. Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: A review. Adv Surg. 2010;44:29-47.
  13. Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, Rummans T, Swartz K, Novotny PJ, Sloan J, Oreskovich MR. Special report: Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54-62.
  14. Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: A review. Thor Surg Clin. 2011;21(3):417-430.
  15. Shanafelt TD, Sloan JA, Satele D, Balch CM. Why do surgeons consider leaving practice? J Am Coll Surg. 2011;212(3):421-422.
  16. Balch CM, Oreskovich MR, Dyrbye LN, Colaiano JM, Satele D, Sloan JA, Shanafelt TD. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657-667.
  17. West CP, Dyrbye LN, Satele D, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med. 2012;27(11):1445-1452.
  18. Balch CM, Shanafelt TD, Sloan JA, Satele D, Freischlag JA. Distress and career satisfaction among 14 surgical specialties: Comparing academic and private practice. Ann Surg. 2011;254(4):558-568.
  19. Balch CM, Shanafelt TD. Burnout among surgeons: Whether specialty makes a difference. Arch Surg. 2011;146(2):385.
  20. Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele D, Hanks JB, Sloan JA, Balch CM. Avoiding burnout: The personal health habits and wellness practices of U.S. surgeons. Ann Surg. 2012;255(4):625-633.
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Governors’ Socioeconomic Issues Committee http://bulletin.facs.org/2013/04/gov-socioeconomic-issues/ http://bulletin.facs.org/2013/04/gov-socioeconomic-issues/#comments Mon, 01 Apr 2013 05:52:26 +0000 http://bulletin.facs.org/?p=5145

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.

Future directions

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

Liaison Members

Adnan Ali Alseidi, MD, FACS

James Clinton Denneny III, MD, FACS

Elan R. Witkowski, MD

Ex-Officio

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

Consultant

John Chingswei Chen, MD, FACS

Staff

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.

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Governors’ Committee to Study the Fiscal Affairs of the College http://bulletin.facs.org/2013/04/study-the-fiscal-affairs/ http://bulletin.facs.org/2013/04/study-the-fiscal-affairs/#comments Mon, 01 Apr 2013 05:51:33 +0000 http://bulletin.facs.org/?p=5148

As the Board of Governors is currently reorganizing its committee structure to align with the major pillars of the College, members of the Committee to Study the Fiscal Affairs of the College and the Executive Committee of the Board of Governors determined that this committee was essential to provide transparency to the Board of Governors and should continue to exist.

The American College of Surgeons (ACS) Board of Governors established the Committee to Study the Fiscal Affairs of the College to review the College dues structure, analyze and monitor the College’s financial matters in order to ensure the overall financial integrity of the College, and communicate concerns or questions regarding College programs, dues structure, allocation of resources, and other financial matters to the Board of Regents. As Secretary of the Board of Governors, I continue to chair this committee and to serve as a member of the Finance Committee and Compensation Committee for the Board of Regents.

Maintaining transparency

As the Board of Governors is currently reorganizing its committee structure to align with the major pillars of the College, members of Committee to Study the Fiscal Affairs of the College and the Executive Committee of the Board of Governors determined that this committee was essential to provide transparency to the Board of Governors and should continue to exist.

Over the past year, the committee has met by conference call and in person to fulfill its responsibilities and to provide a transparent review of the College’s financial matters.

Financial stability

The committee reviewed the consolidated financial statements of the College for fiscal year 2012 and is pleased to report that the College remains fiscally sound. In addition, the committee has reviewed the 2012 resource allocation data as well as the discrete cost methodology adopted by the College. Review of these data indicates that resource allocation is consistent with the strategic goals and objectives of the College and is well aligned with the organization’s mission.

The committee has also reviewed the allocation of dues to dues-supported programs. Once again, dues-supported program costs exceed dues revenue by a considerable amount. This disparity highlights the value of ACS membership given our current dues structure. ACS staff provided the 2013 budget projections as well as the 2014 preliminary budgets and forecast that the committee reviewed. Review of these data indicates the College’s Finance and Accounting staff are using strong budgeting practices.

The Investment Subcommittee of the Finance Committee of the Board of Governors met during the 2012 Clinical Congress and, at press time, was scheduled to meet again in March 2013. The investment performance report provided by Cambridge Associates indicates that the College is using a sound investment strategy that is consistent with the organization’s goals.

The Board of Governors’ Committee to Study the Fiscal Affairs of the College serves an important role in assuring the members of the College and the Board of Regents that the ACS is in sound fiscal condition and has the appropriate resources to meet the strategic goals of the organization.

Members of the Governors’ Committee to study the Fiscal Affairs of the College

William G. Cioffi, Jr., MD, FACS, Chair

J. Craig Collins, MD, FACS, Vice-Chair

Anthony Atala, MD, FACS

Adam J. Cohen, MD, FACS

John Edward Garry, MD, FACS

Jon M. Greif, DO, FACS

James C. Hebert, MD, FACS

Don K. Nakayama, MD, FACS

Timothy D. Sielaff, MD, FACS

Robert Peter Sticca, MD, FACS

Liaison Member

Mathew Thomas, MB, BS, FACS, Resident and Associate Society Liaison

Ex-Officio

Andrew L. Warshaw, MD, FACS

Staff

Jamie Kazay, ACS Division of Member Services

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Governors’ Committee on Chapter Relations http://bulletin.facs.org/2013/04/chapter-relations/ http://bulletin.facs.org/2013/04/chapter-relations/#comments Mon, 01 Apr 2013 05:50:55 +0000 http://bulletin.facs.org/?p=5150

The Board of Governors’ Committee on Chapter Relations (GCCR) had a very busy year. Last year, the GCCR was structured into 10 geographic areas representing groups of state chapters. Following the annual meeting at the 2011 Clinical Congress, the committee functioned during 2012 principally through the use of conference calls. These calls included discussion of several individual subcommittee projects.

Meanwhile, the Board of Governors (B/G) has been undergoing a redesign under the direction of B/G Chair Lena Napolitano, MD, FACS. An ad hoc committee was appointed for this purpose at the close of the Governors’ meetings held during the 2012 Clinical Congress. Although still a work in progress, some aspects of that redesign will be discussed in this summary of the GCCR’s activities over the last year.

Increasing diversity

As an advocate and resource for all chapters of the American College of Surgeons (ACS), the GCCR has evolved into a diverse assembly of Governors representing U.S. Fellows and as an emerging voice for ACS Fellows throughout the world. The ACS now has 65 U.S. chapters, two Canadian chapters, and 37 international chapters. All chapters are increasingly emphasizing inclusion of women and minorities, as well as Fellows representing different surgical subspecialties, when selecting ACS Governors, Council Members, and Officers.

The International Governors are currently represented under the umbrella of the GCCR as the International Affairs Subcommittee; however, due to their recent growth and increased visibility, they will soon be organized into the Chapter Activities International Workgroup. Ray Price, MD, FACS, a general surgeon from Murray, UT, currently chairs the subcommittee and will lead the workgroup as well. Both the national and the international workgroups will be part of the Member Services pillar of the Governors’ new organizational structure under the leadership of Patricia L. Turner, MD, FACS, Director of the ACS Division of Member Services, working with Fabrizio Michelassi, MD, FACS, and will be composed almost exclusively of Governors. During last year’s committee meeting the GCCR voted unanimously to include a volunteer group of Chapter Executives as consultant members of the committee, reflecting the close partnership that exists between chapter leaders and their management teams.

Advocacy

The Advocacy and Coalitions Subcommittee, chaired by David McAneny, MD, FACS, associate professor of surgery, Boston University School of Medicine, continued its charge to provide synergy to national advocacy efforts through review of grants from state chapters participating in the ACS Chapter Advocacy Grant Program. The College provided $35,000 in Lobby Day funding grants, an average of $2,200 per grant, to state chapters for advocacy efforts. Participating chapters included Alabama, Northern California, Connecticut, Florida, Georgia, Illinois and Metro Chicago, Indiana, Kansas, Maine, Massachusetts, Michigan, North Carolina, Ohio, Oregon, Tennessee, and Virginia.

At press time, plans were under way to launch a grassroots advocacy program through which Fellows will regularly visit their U.S. legislators and congressional staff in their district offices. The Massachusetts Chapter of the ACS is working with the Division of Advocacy and Health Policy to begin pilot testing the plan. Details will be published in the Bulletin.

This subcommittee also assisted in reviewing and selecting recipients of the Arthur Ellenberger Award for Excellence in State Advocacy. This award is named for Art Ellenberger, the longtime, now-retired Executive Director of the New Jersey Chapter and expert in grassroots and advocacy. The award is presented to “recognize a career of outstanding leadership and distinguished service and commitment to protecting patients’ access to high-quality surgical care by their involvement with their state’s legislative regulatory process.” The Advocacy and Coalitions Subcommittee provided recommendations to the final selection committee. In 2012, John Maa, MD, FACS, a general surgeon in San Francisco, CA, received the Ellenberger Award in recognition of his work in state advocacy with the Northern California Chapter.

Best practices

Each year at Clinical Congress, ACS chapter leaders from Maine to Hawaii convene to discuss what works and what doesn’t when it comes to making their chapters successful. The event is a must-attend meeting for incoming officers of state chapters and those interested in chairing committees within the chapter. In years past, the meeting was called the Chapter Showcase, but it was recently renamed Best Practices to Keep Chapters Running Smoothly.

The 2012 Best Practices session focused on four specific aspects of chapter administration:

  • Managing the chapter’s finances
  • Encouraging residents’ involvement
  • Providing self-assessment continuing medical education (CME) programming at chapter meetings
  • Engaging in strategic planning

A brief synopsis is provided here, but the presentations in their entirety may be found on the ACS website.

Financial management. Running a state chapter is much like running a small business. Some chapters are of a sufficient size that a professional management firm is paid to conduct the day-to-day business of the chapter, which may include the collection of dues, planning of executive committee and council meetings, and so on. Larger chapters with a diverse range of activities may have robust operating budgets and host large annual meetings, which may translate into a significant number of financial transactions. Keeping up with this complexity requires some basic accounting and financial management skills.

Resident involvement. Astute chapter leaders recognize the value of recruiting members into the College early, and surgical residency is an excellent place to start. Most chapters and the College itself provide significant financial relief for residents to attend annual chapter meetings. Popular resident sessions, such as Surgical Jeopardy and resident paper competitions, also serve to promote another source of scholarship support that surgeons in training may pursue.

Self-assessment CME. Most medical and surgical boards now require that a certain percentage of CME credits obtained to satisfy Maintenance of Certification requirements involve self-assessment activities (SA CME). In other words, it is no longer sufficient to sign in to a lecture, listen, and return home. The activity must involve an assessment of the attendee’s comprehension of the material presented. Self-assessment may take place in the form of a written or electronic question-and-answer exercise that assesses the surgeon’s understanding of the material presented in the CME program—most commonly a short test following the presentation. Many chapters have incorporated SA CME into their annual meetings and there are a few details that must be attended to in this regard, such as guidelines regarding question format and the availability of online testing.

Strategic planning. A formal planning process to identify the mission of any organization is central to its success. Many large corporations regularly involve several levels of the organization in the process of strategic planning. Since chapters vary widely depending on their geographic location, size, and make-up, the strategic planning process can be tailored to have maximal effect to achieve the goals of the chapter.

Each ACS chapter has a core mission and carries out activities that are specific to its mission. Some chapters are heavily involved in advocacy, retaining lobbyists for legislative efforts at the state level; others work through their state medical societies to achieve this goal. A number of chapters offer high-quality annual meetings that feature authoritative speakers on surgical, legislative, and other topics. The organization and planning of a state chapter meeting is a significant undertaking. Attendees at the 2012 Best Practices to Keep Chapters Running Smoothly session in Chicago, IL, suggested that the 2013 session include a presentation on the crucial factors leading to a successful annual meeting of a chapter. A session on planning annual meetings will be presented at 2:30 pm on Tuesday, October 8, at the 2013 Clinical Congress in Washington, DC, along with another session focusing on the Chapter Performance Checklist.

Promoting ACS goals and mission

A key component of a chapter’s success rests in part in its ability to mirror the activities of the College. For example, chapters that have councils composed of Fellows who are involved in the Commission on Cancer, the Committee on Trauma, and other key College programs, such as the ACS National Surgical Quality Improvement Program®, tend to have a depth and breadth of activity in these areas that spills over into the entire chapter membership.

One way a chapter may assess how well it is doing in terms of fulfilling the goals and objectives of the College is through thoughtful completion of the Chapter Performance Checklist. Far from a report card on chapter activities, this field guide to success was developed more than a decade ago by what will soon become the Chapter Activities National Workgroup under the Board of Governors’ redesign. The checklist is useful in helping chapters to identify activities that will better serve its members while maintaining the focus of the overall mission of the College.

Time of transition

As the Board of Governors redesign progresses, the GCCR will transition into the Chapter Activities National Workgroup, renewed and re-invigorated to provide state chapters with the resources they need to be successful. The Chapter Activities International Workgroup will be given additional visibility, and we can undoubtedly expect our international surgical colleagues to offer great ideas and projects that will increase the College’s stature throughout the world. The chapter representation on the Health Policy and Advocacy Group will certainly strengthen the ties between national and state advocacy efforts. Governors interested in serving the College by improving their state chapters are encouraged to get involved in the endeavors of these evolving groups of extraordinary College leaders.

Members of the Governors’ Committee on Chapter Relations

Renamed: Chapter Activities (Domestic) Workgroup

John P. Rioux, MD, FACS, Chair

Samual Robert Todd, MD, FACS, Vice-Chair

John H. Armstrong, MD, FACS

Miguel Angel Cainzos, MD, FACS

Gregory Spicer Cherr, MD, FACS

David W. Dexter, MD, FACS

Stephen Edmund Ettinghausen, MD, FACS

Daniel S. Johnson, MD, FACS

Matthew B. Martin, MD, FACS

Eric Zenko Matayoshi, MD, FACS

David B. McAneny MD, FACS

Raymond R. Price, MD, FACS

Gary L. Timmerman, MD, FACS

Bruce J. Waring, MD, FACS

Chapter Activities (International) Workgroup

Quyen D. Chu, MD, FACS

Jamal J. Hoballah, MD, FACS

Fabrizio Michelassi, MD, FACS

Staff

ACS Division of Member Services

Patricia L. Turner MD, FACS, Director

Mark Chou

Jamie Kazay

Donna Tieberg

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Governors’ Committee on Socioeconomic Issues http://bulletin.facs.org/2012/10/socioeconomic-issues/ http://bulletin.facs.org/2012/10/socioeconomic-issues/#comments Tue, 09 Oct 2012 05:25:03 +0000 http://bulletin.facs.org/?p=3113

T he American College of Surgeons (ACS) Board of Governors’ Committee on Socioeconomic Issues has been very busy this past year.

Surgeons as employees

The committee’s activities have centered largely on the development of a white paper addressing the roles and future of surgeons as employees. The committee believes this is an important issue in light of the fact that a large number of graduating residents as well as established surgeons are now negotiating contracts with large multispecialty groups, health systems, or hospitals.

The committee determined that the white paper should address a broad number of issues that these surgeons may face and should consider when deciding whether to sign contracts as well as other matters of concern related to employed surgeons. These considerations include the following:

  • What is the vision and mission of the institution?
  • What are its values?
  • What role will physicians play in leadership?
  • What is the clinical service model in which they may be engaged?
  • What are the patients’ needs?
  • How is the physician to remain an effective patient advocate?
  • What are the strategies for meeting financial requirements?
  • Are physicians valued beyond their role as simply providers of clinical care?

The committee’s white paper will also address complex and multilayered questions and topics related to the subject of surgeons as employees, including the following:

  • Will physician compensation be set at market rates?
  • Will related centers be aligned within the system’s goals?
  • Will physicians work in clinical teams with other physicians for the benefit of patient care and services?
  • Will physicians collaborate, develop, and accept the policies for best practices and evidence-based clinical managerial outcomes?
  • Will physicians be held accountable to peers and the system for their professional behavior and abide by organizational values or an approved code of conduct?
  • Will physicians operate with a common employment agreement in terms of distances  and of individuals’ clinical specialties?
  • Will physician clinical practice be governed by credentialed privileging criteria policies and procedures as developed by other physicians in the systems?

These are just some of the questions that will be addressed in this white paper, which the committee believes will be of value to Fellows and other members of the College as health care continues to evolve and change.

Health care reform

In addition to the white paper on employed surgeons, the Committee on Socioeconomic Issues has continued to focus on the topics that relate to the overall ability of surgeons to maintain their practices and provide quality patient care. In particular, the committee continues to be concerned about the requirements in and implementation of the Affordable Care Act (ACA). These concerns very much relate to physician reimbursement and bundled payments for procedural-based care. The committee understands the need as well as the overall desire to reduce costs in health care, efforts which most physicians support.

However, the committee believes the provisions in the ACA will put a number of physicians at risk for reduced compensation and, thereby, will add to the significant shortage of physicians.

The white paper is relevant to the College’s ability to address these issues as well, because many of these factors will drive consolidation of health systems, create incentives for physicians to be employed, and will drive private physician groups into near extinction—particularly due to the cost of adopting electronic health records, which are central to many of the ACA’s provisions.

Furthermore, the ACA seeks to move patients into integrated health systems known as accountable care organizations (ACOs).  The committee is concerned that ACOs will become not only medical homes for patients, but will be at the forefront of reducing the total cost of care. In this role, it is likely that ACOs will often see surgeons not as producers of quality outcomes, case volume, or revenue, but as cost centers. This situation is likely to arise if primary care physicians are perceived as gatekeepers while surgeons become viewed as the providers who drive up costs.

These issues are of significant concern to the members of the committee and, we believe, reflect in many ways the concerns of the constituents of the College and its Fellows. The committee believes it is critically important that the College educate Congress about the value of surgeons in delivering health care and the significant and real shortage of general surgeons, especially in rural areas—a problem that is likely to increase as Baby Boomers retire and physicians become more aligned with health systems in major metropolitan areas.

Outreach

The committee also focused—as it has over the last several years—on medical missions. These missions have become an increasing important part of life for academic, employed, and private practice physicians. Medical missions provide an opportunity for physicians to give back in areas of significant need, not only in this country but more often abroad in developing countries, which benefit very much from skilled physicians who are willing to give of their time, energy, and effort to train health care professionals and treat patients who are in desperate need of surgical expertise.

This year’s Volunteerism Award recipients continued to reflect the outstanding contribution by surgeons and the overall growth of interest in this field. The committee had numerous applicants for each of the outreach positions, and after a thorough review process the committee selected two winners who will be honored at the 2012 Clinical Congress. The committee believes medical missions will continue to be a growing trend for many members of the College who, informally and formally, provide services abroad. Today, many trainees in surgical programs are exposed to this setting, which may lead to the development of a pipeline of surgeons committed to serving in medical missions. The interest in medical missions continually drives home awareness of both the fortune and opportunities that we still have in America to practice as surgeons and the compelling need that we see abroad for many of our surgeons to take the lead in caring for others.

Quality and outcomes

Issues related to quality and outcomes in care continue to be a priority for the committee. Joseph Tepas, MD, FACS, Vice-Chair of the Committee on Socioeconomic Issues, has led the initiative to further define the quality of care and to encourage physicians to establish quality care guidelines and initiatives in their own hospitals and in their region. It is clear that many efforts to improve outcomes in health care will be geared toward improving quality in procedural-based medicine. This probability means that surgeons have a real chance to be engaged in a collaborative effort with their hospitals and their health systems to implement quality metrics, which, with or without our input, will often be used  to determine pay and reimbursement, and to measure the overall performance of a physician group or a hospital. We believe that engagement in these efforts will best serve our patients and our profession in the future.

Members of the Governors’ Committee on Socioeconomic Issues

Selwyn M. Vickers, MD, FACS, Chair
Joseph J. Tepas III, MD, FACS, Vice-Chair
David B. Adams, MD, FACS
David R. 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
John Chingswei Chen, MD, FACS
David W. Cloyd, MD, FACS
Walter C. Dandridge Jr., MD, FACS
Anthony D. Dippolito, MD, FACS
Mary E. Fallat, MD, FACS
Aaron S. Fink, MD, FACS
Daniel P. Harley, MD, FACS
Andrea Anita Hayes-Jordan, MD, FACS
Burton L. Herz, MD, FACS
Tyler G. Hughes, MD, FACS
Edwin L. Kaplan, MD, FACS
James L. Kesler, MD, FACS
Joel D. Lafleur, MD, FACS
David N. Linz, MD, FACS
Deborah Susan Loeff, MD, FACS
Nipun B. Merchant, MD, FACS
Mark William Moritz, MD, FACS
Susan L. Orloff, MD, FACS
Robert V. Rege, MD, FACS
James Aloysius Reilly, Jr., MD, FACS
Chad A. Rubin, MD, FACS
Howard Lawrence Sussman, MD, FACS
Nicholas Blair Vedder, MD, FACS
Matthew J. Wall Jr., MD, FACS
Lewis Wetstein, MD, FACS

Liaison Members
David Seth Aaronson, MD
Adnan Ali Alseidi, MD, FACS
James Clinton Denneny III, MD, FACS

Ex-Officio
John H. Armstrong, MD, FACS
Kathleen M. Casey, MD, FACS
Charles D. Mabry, MD, FACS
John Gerard Meara, MD, FACS
Andrew L. Warshaw, MD, FACS

Staff
Patricia Sprecksel, ACS Division of Member Services

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Governors’ Committee on Physician Competency and Health http://bulletin.facs.org/2012/09/governors-committee/ http://bulletin.facs.org/2012/09/governors-committee/#comments Sat, 01 Sep 2012 05:26:12 +0000 http://bulletin.facs.org/?p=2543

Acknowledging the multiple challenges surgeons currently face, the Board of Governors’ Committee on Physician Competency and Health has continued its efforts to both delineate these issues and provide educational programs and support services aimed at promoting physician well-being. The previous chairs and members of the committee have laid a solid groundwork upon which the present committee has expanded.

The Committee on Physician Competency and Health’s responsibilities include developing recommendations on the maintenance of physical and mental wellness in the Fellows as well as addressing issues related to surgical competency with an emphasis on credentialing and practice within expected community standards.

Surgeon stressors

Most physicians are aware that wellness encompasses the physical, emotional, and spiritual aspects of life. Input from Fellows of the College indicates that many surgeons are either personally or professionally coping with significant stressors that have the potential to negatively affect not only their individual well-being, but also their ability to provide optimal patient care.

Surgical education and training are intensely rigorous, and the transition to practice may be even more stressful. Contemporary surgical practice is replete with challenges, including providing patient care to an enlarging population of increasing medical complexity, and coping with declining resources and reimbursement, yet with increasing administrative burdens.

Adding to these stresses are the demands associated with maintaining work-home balance, functioning as an effective part of a health care team, meeting the professional requirements for certification, while functioning in a litigious environment.

The subsequent transition from active practice to retirement is one that many surgeons approach with trepidation and denial, and has been shown to be a difficult phase for practicing surgeons.

Measuring well-being

Although abundant anecdotal information regarding surgeon stress and stressors existed, no studies had been performed that examined how these problems affected large numbers of surgeons.

Using an anonymous electronic tool developed by Gerald J. Bechamps, MD, FACS, and members of the Physician Competency and Health Committee, the College conducted a study of the Fellows in 2008. Nearly 8,000 Fellows responded to the survey, which asked questions related to both personal characteristics and professional obligations. Also included were questions designed to measure burnout and depression, career satisfaction, perception of quality of life, and issues related to the occurrence of medical error. Significant findings from this survey included a high prevalence of burnout and depression, as well as a considerable occurrence of suicidal ideation. Nonetheless, most surgeons said they enjoyed a good quality of life and level of career satisfaction.1-5

With the College’s support, another anonymous electronic survey of the Fellows was completed in 2010, with questions addressing interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. Of the nearly 7,200 respondents, nearly one-quarter reported involvement in a medical liability lawsuit in the past two years.6

Surgeons involved in these lawsuits tended to be younger, worked more hours, took more night call, and were more often in private practice. Depression and burnout were independently associated with a recent malpractice suit; however, because of the nature of the survey, no causality can be identified. Not surprisingly, surgeons involved in recent legal action reported less career satisfaction.

The data showed that alcohol was by far the most widely used or abused substance. Using the Alcohol Use Disorders Identification Test, Version C, to evaluate for the presence of alcohol abuse or dependence, 15 percent of surgeons had scores consistent with alcohol-use disorders, which exceeds rates quoted for the general population.7 The rate for male surgeons was 14 percent, and the reported rate for female surgeons was 25 percent. A correlation was also found between surgeons reporting alcohol abuse or dependence and the occurrence of a major medical mistake within the previous three months. A strong association with burnout, particularly in the areas of emotional exhaustion and depersonalization, also was noted.

Other studies have indicated that a surgeon who is struggling with impairment often will avoid assistance until forced to do so. Additionally, probably because of the achievement-driven, highly responsible surgeon personality, work performance and attendance will be maintained, although the surgeon may be struggling significantly in all other aspects of life. It is also clear that, likely due to this commitment to patient care, direct harm to patients as a result of surgeon impairment is exceedingly rare.

A literature review also indicates that the prognosis for successful outcomes when alcohol abuse and dependence are treated is very good, with most surgeons being able to return to active practice.8,9 Participation in an established program, with ongoing support from the hospital or academic department and colleagues, as well as long-term, supervised monitoring are also essential to a successful recovery.10

Avoiding burnout

Additional areas of assessment from the 2010 survey have looked at the role of personal health care practices and strategies in avoiding burnout in surgeons. According to the study, surgeons who had seen their primary care provider within the past year were found to have better overall quality of life scores and to be current with recommended health screenings. Making a deliberate effort to maintain a perspective on work-life balance as well as identifying personal values and priorities in life and gaining a sense of meaning from work were found to counteract burnout.11,12 Although stress and intense demands are inherent to the surgical lifestyle, it is essential to identify and develop successful tactics to address them.

Looking forward

Although recognition and acknowledgement of these issues is critically important, further steps must be taken to properly aid our colleagues. These actions include: (1) assuring the individual who is struggling with these issues that they are not alone and need not continue in isolation; (2) encouraging group practices and surgery departments to put into place support mechanisms for prevention, recognition, and assistance; (3) identifying and sharing available resources; and (4) educating the surgeon that the prognosis is good for recovery and that there is a strong likelihood of continuing to function competently.

The Governors’ Committee on Physician Competency and Health has been engaged in an extensive effort to produce a resource document for both the surgeon and departments of surgery that addresses surgeon well-being. We anticipate that this document will be available electronically in the near future.

The challenges mentioned here are certainly not limited to surgeons practicing in North America; studies in other parts of the world show similar findings. The committee welcomes the input and participation of international colleagues.
A large number of manuscripts have already been published from the survey data; several more are under way.

Additionally, we anticipate another survey of ACS Fellows. With significant recent changes in employment patterns as well as recognition of the stresses of career transitions and important differences between the genders, it is imperative that we broaden our understanding and then use this knowledge to guide our progress. The issues confronting surgeons are wide-ranging and have crucial implications for the individual surgeon—and the profession.

Members of the Governors’ Committee on Physician Competency and Health

Krista L. Kaups, MD, FACS, Chair
Michael Coburn, MD, FACS, Vice-Chair

James A. Anderson, MD, FACS
Jeffrey O. Anglen, MD, FACS
Karen J. Brasel, MD, FACS
Adam Deutchman, MD, FACS
Clifford W. Deveney, MD, FACS
Christian M. deVirgilio, MD, FACS
Richard E. Fine, MD, FACS
James W. Fleshman, Jr., MD, FACS
Daniel J. Frey, MD, FACS
Eric R. Frykberg, MD, FACS
Kevin O. Garrett, MD, FACS
Nelson H. Goldberg, MD, FACS
Michael T. Jaklitsch, MD, FACS
Lynne M. Jalovec, MD, FACS
Gerald H. Jordan, MD, FACS
Scott H. Kurtzman, MD, FACS
Warren E. Lichliter, MD, FACS
R. Russell Martin, MD, FACS
Ernest E. Moore, Jr., MD, FACS
Roger R. Perry, MD, FACS
Hugh E. Scully, MD, FACS
Ralph W. Stewart, MD, FACS
Michael P. Vezeridis, MD, FACS
Gerald J. Bechamps, MD, FACS, Consultant
Michael R. Oreskovich, MD, FACS, Consultant
Edwin W. Shearburn III, MD, FACS, Consultant
Dinakar Golla, MD, FACS, Liaison
Lorrie A. Langdale, MD, FACS, Liaison
Brian J. Santin, MD, FACS, Liaison

Staff: Patricia Sprecksel, ACS Division of Member Services


Acknowledgements
The author would like to acknowledge the previous Chairs of the Governors’ Committee on Physician Competency and Health: Kenneth W. Sharp, MD, FACS; Gerald J. Bechamps, MD, FACS; and John B. Hanks, MD, FACS, who have provided exemplary leadership in developing the scope of the committee’s work. Additionally, Tait Shanafelt, MD, and his colleagues at the Mayo Clinic have continued to provide outstanding technical and data analysis support.


References

  1. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag JA. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
  2. Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, Freischlag JA. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg. 2010;211(5):609-619.
  3. Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, Rummans T, Swartz K, Novotny PJ, Sloan J, Oreskovich MR. Special report: Suicidal ideation among American surgeons. Arch Surg. 2011;146(1);54-62.
  4. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg. 2011;146(2):211-217.
  5. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg. 2011;254(4):558-568.
  6. Balch CM, Oreskovich MR, Dyrbye LN, Calaiano JM, Satele DV, Sloan JA, Shanafelt TD. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657-67.
  7. Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, Meredith C, Buhl A, Dyrbye LN, Shanafelt TD. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168-174.
  8. Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007;35:S106-S116.
  9. Domino KB, Horbein TF, Polissar NL, Renner G, Johnson J, Alberti S, Hankes L. Risk factors for relapse in health care professionals with substance use disorders. JAMA. 2005;293:1453-1460.
  10. Buhl A, Oreskovich MR, Meredith CW. Prognosis for the recovery of surgeons from chemical dependency: A 5-year outcome study. Arch Surg. 2011;146(11):1286-1291.
  11. Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele DV, Hanks JB, Sloan JA, Balch CM. Avoiding burnout: The personal health habits and wellness practices of U.S. surgeons. Ann Surg. 2012;255(4):625-633.
  12. Bittner JG, Khan Z, Babu M, Hamed O. Stress, burnout and maladaptive coping: Strategies for surgeon well-being. Bull Am Coll Surg. 2011;96(8):17-22.
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ACS Board of Governors committee updates: Governors’ Committee to Study the Fiscal Affairs of the College http://bulletin.facs.org/2012/07/acs-board-committee-of-governors-updates-governors-committee-to-study-the-fiscal-affairs-of-the-college/ http://bulletin.facs.org/2012/07/acs-board-committee-of-governors-updates-governors-committee-to-study-the-fiscal-affairs-of-the-college/#comments Sun, 01 Jul 2012 05:41:24 +0000 http://bulletin.facs.org/?p=1660

The Board of Governors (B/G) Committee to Study the Fiscal Affairs of the College has three major responsibilities: (1) review the American College of Surgeons’ (ACS) dues structure and recommend approval of any changes to the dues structure; (2) understand and monitor the College’s financial matters in order to ensure the overall financial integrity of the College; and (3) serve as a liaison body to communicate concerns or questions regarding College programs, dues structure, allocation of resources, and other financial matters from the B/G to the Board of Regents. As Secretary of the B/G, I serve as Chair of this committee, and I am also a member of the Finance Committee and the Compensation Committee of the Board of Regents.

Over the past year, the Committee to Study the Fiscal Affairs has met by conference call and in person to fulfill our responsibilities. The committee has reviewed the consolidated financial statements of the College for fiscal year 2011. Despite the economic recession, the College remains fiscally sound. The committee has reviewed the 2011 resource allocation data, as well as the discrete cost-finding methodology adopted by the ACS. Review of these data indicates that resource allocation is consistent with the strategic goals and objectives of the College and is well-aligned with the organization’s major missions.

Dues structure

The committee was tasked two years ago with reviewing the dues structure of the College and with formulating a long-term dues policy to be presented to the Board of Regents. After multiple meetings, which included an open discussion at the annual meeting of the B/G, the Fiscal Affairs Committee recommended an annual dues increase of up to 3 percent annually. The Board of Regents may suspend this dues increase in any given year. The Regents approved this policy.

The committee has reviewed the allocation of dues income to dues-supported programs. The cost of dues-supported programs exceeds dues revenue by approximately $4 million, yielding a total program cost of approximately $579 per member versus an average of $456 dues revenue per member. These data highlight the value of College membership. The committee has also reviewed the 2012 budget projections, as well as the 2013 preliminary budgets and the College’s financial forecast. Review of these data indicates that the College’s management is adhering to strong budgeting practices and that the College can look forward to continued fiscal stability.

Investments

The Investment Subcommittee of the Finance Committee of the Board of Regents met on February 9 and reviewed the investment performance report provided by Cambridge Associates. Despite particular volatility within the markets, the investment strategy that the College used outperformed most comparative indexes.

In conclusion, the Board of Governors Committee to Study the Fiscal Affairs of the College has exercised its responsibility to review the financial status of the ACS. The ACS is in sound fiscal condition and has the appropriate resources to continue to enact the strategic goals of our organization.

Governors ‘ Committee to Study the Fiscal Affairs of the College

William G. Cioffi, Jr., MD, FACS, Chair
J. Craig Collins, MD, FACS, Vice-Chair
Adam J. Cohen, MD, FACS, Young Fellows Association Liaison
Mathew Thomas, MB, BS, Resident and Associate Society Liaison
Anthony Atala, MD, FACS, Member
Jon M. Greif, DO, FACS, Member
James C. Hebert, MD, FACS, Member
Timothy D. Sielaff, MD, FACS, Member
Robert Peter Sticca, MD, FACS, Member
Andrew L. Warshaw, MD, FACS, Ex-Officio
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ACS Board committee of Governors updates: Governors’ Committee on Chapter Relations http://bulletin.facs.org/2012/07/chapter-relation/ http://bulletin.facs.org/2012/07/chapter-relation/#comments Sun, 01 Jul 2012 05:37:56 +0000 http://bulletin.facs.org/?p=1656

The Governors’ Committee on Chapter Relations (GCCR), previously the Governors’ Committee on Chapter Activities, serves as an advocate for all of the American College of Surgeons’ (ACS) chapters, and monitors and reports on chapters’ activities, resources, and issues. The GCCR reports to the Board of Governors (B/G), and to the B/G Executive Committee. The GCCR is staffed by the College’s Division of Member Services. As of January, the ACS has a total of 103 chapters: 64 in the U.S., two in Canada, and 37 throughout the rest of the world.

The GCCR has undertaken a number of activities over the last year. In a lengthy meeting of the committee during the 2011 Clinical Congress in San Francisco, CA, the members of the committee agreed to a restructuring so as to better align the GCCR with the College’s ongoing agenda, with a view toward avoiding duplication of activity. As a result, the GCCR members decided to change the committee’s name to better reflect its activities. The committee also agreed that the GCCR Vice-Chair should serve at least a one- or two-year term, before becoming Chair; this change in the GCCR guidelines will provide for successful leadership transitions in the future. The committee also created an executive committee to coordinate the activities of each of the subcommittees. All of these groups now meet via conference call on a quarterly basis.

Committee members also agreed to eliminate one of the GCCR’s four subcommittees in an effort to better focus their efforts and activities. The Subcommittee on Diversity was dissolved in light of the fact that the College has a strong interest in and is focusing on expanding opportunities and activities for a wide variety of surgeons, and is involved in a robust, ongoing effort to increase diversity. The remaining three subcommittees were realigned as follows.

Advocacy & Coalitions (A&C)

This subcommittee is responsible for increasing and supporting advocacy activities at the chapter level. David McAneny, MD, FACS, a general surgeon in Boston, MA, chairs this subcommittee, which is developing a pilot program for congressional grassroots advocacy. With assistance and close coordination with the College’s Health Policy Advocacy Council and the Division of Advocacy and Health Policy (DAHP), the Massachusetts and Tennessee chapters will participate in this grassroots demonstration project. Participants will meet locally with members of Congress in their home offices during recesses, and so forth.

In addition, the A&C Subcommittee assists the DAHP with two chapter-related activities. The first program, the ACS Chapter Advocacy Grant Program, provides grants to chapters to sponsor and/or host state lobby days. This grant program, which is managed by the DAHP State Affairs staff, provided grants to 17 chapters in 16 states for 2012 Lobby Days: Alabama, Northern California, Connecticut, Florida, Georgia, Illinois, Metropolitan Chicago, Indiana, Kansas, Maine, Massachusetts, Michigan, North Carolina, Ohio, Oregon, Tennessee, and Virginia.

For the second program, also managed by the DAHP State Affairs staff, the A&C Subcommittee assists in reviewing and selecting recipients of the Arthur Ellenberger Award for Excellence in State Advocacy. This award is named for Art Ellenberger, the long-time (now retired) Executive Director of the New Jersey Chapter and expert in grassroots advocacy. The award is presented to “recognize a career of outstanding leadership and distinguished service and commitment to protecting patients’ access to high-quality surgical care by their involvement with their state’s legislative and regulatory process.” The A&C Subcommittee reviews the nominations and provides recommendations to the final selection committee.

In 2011, James Hamilton, Jr., MD, FACS, President of the Kansas Chapter of the ACS, received the Ellenberger Award. Dr. Hamilton has been a steadfast advocate for a clean indoor air ordinance, which the Kansas legislature passed in 2010. Other recipients of the Ellenberger Award have included Peter Masiakos, MD, FACS, Massachusetts Chapter; Robert Harvey, Florida Chapter (former Executive Director); Thomas Gadacz, MD, FACS, Georgia Chapter; Andrew Warshaw, MD, FACS, Massachusetts Chapter; William Doscher, MD, FACS, New York Chapter; and, of course, Mr. Ellenberger, the inaugural recipient.

Chapter Support (CS)

This subcommittee is responsible for identifying the characteristics of successful chapter organizational structures and education programs and for communicating this information to the chapters. In addition, the CS Subcommittee provides new ideas and topics for presentation at chapters’ educational programs, which may help unify surgical specialists on topics of broad appeal or shared concerns. John Rioux, MD, FACS, a general surgeon from Port Charlotte, FL, is chairing this committee. Dr. Rioux has organized the subcommittee members by region, and the Governors are tasked with providing direct, personal communication with every chapter in their region (see roster, page 28). The CS Subcommittee is pursuing multiple projects, including: (1) strengthening the liaison with chapters; (2) developing checklists for chapter performance; (3) assisting chapters with educational curricula for both continuing medical education (CME) and CME with self-assessment in compliance with Part II of Maintenance of Certification; (4) developing membership strategies; and (5) planning the Best Practice session for chapter leaders for the 2012 Clinical Congress, which will take place on Tuesday, October 2, from 2:30 to 4:00 pm, at McCormick Place convention center in Chicago, IL.

International Activities (IA)

The IA Subcommittee is composed largely of international Governors. In addition, a coordinating committee that includes international Governors and liaisons from the B/G Executive Committee, the International Relations Committee, and the Young Fellows Association has been appointed. The IA Subcommittee serves as a forum or meeting ground for all international Governors. Ray Price, MD, FACS, a general surgeon from Murray, UT, chairs the subcommittee.

The IA Subcommittee is working with all of the international chapters to both improve and facilitate membership in the College. The subcommittee’s current focus is on developing strategies to communicate the benefits of ACS membership to the international community and to work with several specific chapters for recruitment strategies. Also, the IA Subcommittee will review and develop recommendations for the ACS website. Presenting a resource-friendly website could help international members use their ACS membership benefits more effectively.

Lastly, with regard to international advocacy efforts, the international Governors will be asked to seek their country’s support for a World Health Organization draft resolution titled “Surgical Care and Anesthesia.” This resolution addresses the belief that development of health care systems in any nation must include access to, and support for, appropriate surgical care and anesthesia in equal relationship to other critical health care components. As noted in the College’s support letter for the resolution, this recommendation underscores the ACS mission of promoting access to quality, safe, appropriate surgical care; improving the care of the surgical patient; and safeguarding standards of care in an optimal and ethical practice environment. The College’s letter of support will serve as a model for the international Governors who would like to support these advocacy efforts.

Governors’ Committee on Chapter Relations

Member (region)
Kevin P. Lally, MD, FACS, Chair, South Texas Chapter (6)
George M. Fuhrman, MD, FACS, Vice-Chair, Louisiana Chapter (4)
George Alsop, MD, FACS, South Texas Chapter (6)
Gerard V. Aranha, MD, FACS, Metropolitan Chicago Chapter (5)
John Armstrong, MD, FACS, Florida Chapter (4)
Lisa Bailey, MD, FACS, Northern California Chapter (9)
Miguel Cainzos, MD, FACS, Spain Chapter (15)
Gregory Spicer Cherr, MD, FACS, Western New York Chapter (2)
David W. Dexter, MD, FACS, Northwest Pennsylvania Chapter (3)
William G. Hawkins, MD, FACS, Missouri Chapter (7)
Daniel S. Johnson, MD, FACS, Illinois Chapter (5)
Danielle A. Katz, MD, FACS, New York Chapter (2)
Joel D. Lafleur, MD, FACS, Maine Chapter (1)
Matthew B. Martin, MD, FACS, North Carolina Chapter (4)
Eric Matayoshi, MD, FACS, Hawaii Chapter (10)
David B. McAneny, MD, FACS, Massachusetts Chapter (1)
Raymond R. Price, MD, FACS, Utah Chapter (8)
John P. Rioux, MD, FACS, Florida Chapter (4)
Hilary A. Sanfey, MB, BCh, FACS, Illinois Chapter (5)
Samual Robert Todd, MD, FACS, New York Chapter (Manhattan Council) (2)
Bruce J. Waring, MD, FACS, Colorado Chapter (8)
International Relations Committee liaison members
Quyen Chu, MD, FACS (6)
Jamal J. Hoballah, MD, FACS (17)
Fabrizio Michaelissi, MD, FACS (2)
B/G Executive Committee Liaison
Gary Timmerman, MD, FACS, South Dakota Chapter (8)
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