“The goal of this portion of the meeting is to renew our pledge to each other as leaders,” said David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons (ACS) in his opening remarks at the second annual Leadership Conference, which took place April 13–14 at the Mandarin Oriental Hotel in Washington, DC. “We each have a role in the leadership of this organization. Today’s activities are intended to start a conversation to move this organization forward,” added Dr. Hoyt.
The 2013 Leadership Conference—part of a dual meeting with the Advocacy Summit—drew a total of 308 attendees from all levels of the ACS leadership, including Regents, Governors, Advisory Council members, chapter leaders, and others.
A “recommitment to ACS leadership goals” was a central message of this year’s conference, according to Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services. Part of this re-energized focus included the unveiling of a new and expanded list of ACS Board of Governors (B/G) duties presented to conference attendees by Lena M. Napolitano, MD, FACS, Chair of the B/G. The ultimate goal of these new responsibilities—which include required attendance at future Leadership Conference and Advocacy Summit meetings—is to enhance “bi-directional communication between the Board of Governors and their constituents,” explained Dr. Napolitano.
This year’s conference also included a new, interactive component designed to foster relationship-building among like-minded colleagues. Participants convened by geographic location, allowing them to identify areas for synergy and unified effort and to discuss common challenges and potential solutions. A representative from each breakout session presented the findings to the group-at-large. Common themes to emerge from these breakout sessions included a need for increased communication among chapter members, enhanced member engagement, and a desire for professional development training.
Other conference sessions covered a wide spectrum of topics tethered to the meeting’s leadership theme, including presentations on the following: defining roles and responsibilities, a review of ACS infrastructure, enhancing member involvement, and best practices for chapter leaders and executives.
Roles and responsibilities
The first session, titled Roles and Responsibilities, included four presentations by Fellows representing the Regents, Governors, chapters, and Advisory Council chairs with the goal of defining the functions of the individuals in these roles.
Julie A. Freischlag, MD, FACS, Chair of the Board of Regents, outlined the “Top 10 Things a Regent Should Do,” including “attend the Regents’ meetings, prepare for and talk at the Regent meetings, and communicate to your group about the ACS.” She encouraged attendees to develop the ability to learn from others who are Regents, Governors, members of Advisory Boards. “As surgeons we like to talk, but we have to learn to listen,” advised Dr. Freischlag. “All of these people—both younger surgeons and senior surgeons—have valuable information to share.”
Dr. Napolitano’s presentation provided an overview of the enhanced duties of the B/G. “The Governors act as a liaison between the Board of Regents and the Fellows and as a clearinghouse for the Regents on general assigned subjects and on local problems,” she said, quoting the College Bylaws on the duties of the Governor. The B/G’s updated duties incorporate both new and existing responsibilities including:
- Provide bi-directional communication between B/G and constituents
- Participate in B/G pillars and work groups
- Attend B/G meetings: Annual Clinical Congress and Leadership Conference
- Complete annual survey featuring new questions
- Compile annual survey results from constituents and Fellows
- Participate in Clinical Congress Convocation
- Attend Annual Business Meeting of members
- Attend chapter or specialty society meetings
- Provide a report to chapter or specialty society, and provide electronic copy to B/G Executive Committee and the Communications Committee
- Participate in local committee on applicants meetings and interviews
- Promote ACS Fellowship in state or specialty society
- Engage new Initiates
“This new and expanded list of duties will enhance the communication of the B/G over the next several years,” explained Dr. Napolitano. “Our mission is to bring the voice of the Fellows forward so that the Regents can make important decisions.”
Dr. Napolitano urged Governors to promote ACS efforts in the Accredited Educational Institutes program, ACS National Surgical Quality Improvement Program (ACS NSQIP®), and in advocacy efforts, in particular, and she underscored the fact that “Governors are expected to oversee and assist with ACS membership recruitment efforts at the local level.”
In his presentation on the roles and responsibilities of chapter leaders, John P. Rioux, MD, FACS, Chair of the Board of Governors’ National Chapter Workgroup, outlined the key duties of the chapter president, vice-president, secretary, and treasurer. In particular, Dr. Rioux underscored the importance of developing an overall strategic plan, a task traditionally led by the Chapter President. “Plan a strategic planning meeting if one has not already taken place,” he advised. “Develop an operational plan, assign tasks with established timelines, and develop measures of success necessary to fully implement the strategic plan.” Once the plan has been determined, “the vice-president takes an active role in implementing the strategic plan using the communication tools you developed as secretary,” he said.
Dr. Rioux also emphasized chapter council diversity as a key factor in developing a successful, sustainable chapter. “Populate the council with a diverse spectrum of individuals. A variety of views will better allow you to implement the chapter’s strategic plan.”
The final presentation on the topic of ACS leadership roles was an overview of ACS Advisory Councils for the Surgical Specialties, presented by E. Christopher Ellison, MD, FACS, Chair, Advisory Council for General Surgery, and Chair, Advisory Council Chairs. “Since the founding of the College, surgical specialties have been closely integrated into all College activities,” observed Dr. Ellison in his opening remarks. “This is not surprising as the College was conceived by a specialist in gynecology, Dr. Franklin H. Martin.”
The ACS Advisory Councils for Surgical Specialties are responsible for the following activities, according to Dr. Ellison:
- Serve as a liaison for communicating information to and from surgical societies and the Regents
- Advise the Regents on policy matters relating to their specialties
- Nominate Fellows from the surgical specialties to serve on College committees and other organizations
- Provide specialty input into the development of general and specialty sessions for the annual Clinical Congress meeting
Dr. Ellison also proposed a review of the committees and structures of the Advisory Councils to better and more efficiently align with the mission of the College.
Review of ACS Infrastructure
The Leadership Conference’s second block of meetings featured presentations by ACS staff members and others on key areas of the College. “This next section of the agenda is a review of the infrastructure of the American College of Surgeons and highlights the offerings of each division,” explained Dr. Turner. “These presentations are also intended to point out where you, as leaders in your respective roles, can integrate with these programs. It is our expectation that [these overviews] will present opportunities for increased involvement [with the College] and will also highlight opportunities to support the rank-and-file surgeons whom you represent.”
Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education, underscored the division’s “special focus on the two ends of residency training—the transition from medical school to surgery residency and the transition from training to independent surgical practice.” The College’s efforts to enhance the transition from medical school to surgery residency include the development of a publication titled Successfully Navigating the First Year of Surgical Residency, which lists the critical cognitive, clinical, and technical skills necessary for students’ first year of residency training.
In an effort to assist with the transition from training to independent surgical practice, the Division of Education has introduced the new ACS Transition to Practice Program in General Surgery initiative, which helps residents with the following:
- Obtain enhanced autonomous experience in broad-based general surgery
- Increase their competence and confidence in clinical matters
- Gain exposure to aspects of practice management
- Experience mentoring with notable practicing surgeons
- Participate in experiential learning tailored to individual needs
- The program is being rolled out at several facilities in regions currently underserved by general surgery trainees in an effort to address the shortage of general surgeons in those areas. The following institutions have committed to begin pilot testing the ACS Transition to Practice Program in General Surgery:
- Gundersen Lutheran Health System, La Crosse, WI
- Mercer University School of Medicine/Medical Center of Central Georgia, Macon
- Ohio State University (OSU) Wexner Medical Center, Columbus
- University of Louisville School of Medicine, KY
- University of Tennessee College of Medicine, Chattanooga
- Eastern Virginia Medical School, Norfolk
In his concluding remarks, Dr. Sachdeva unveiled a new tagline for the ACS Division of Education: “Blended Surgical Education and Training for Life,” which exemplifies the department’s ongoing mission to “promote excellence and expertise in surgery through innovative education, training, verification, validation, and accreditation,” noted Dr. Sachdeva.
Highlighting the numerous roles and responsibilities of the Member Services Division, Dr. Turner touched on everything from the application process to member recruitment and retention to nominating committees and scholarships and fellowships. All of these areas, as well as the Advisory Councils, the Young Fellows/Residents and Associates, and Operation Giving Back, fall under the aegis of Member Services, and each provides an opportunity for enhanced member engagement, noted Dr. Turner.
“The RAS/YFA is the pipeline for future leaders. If you’re a chair or a program director, encourage or fund participation of your trainees,” suggested Dr. Turner, underscoring the fact that interacting with young surgeons is a golden opportunity for member involvement. “If you’re a part of a chapter which does not currently invite or engage residents, please consider doing so—that may be where your future partners are first integrated into the fabric of the community of surgeons. Many of our most robust chapters with the most engaging meetings incorporate a resident research day or other opportunity to engage surgeons early in their careers.”
“Interview new Fellows with the Committees on Applicants in your local area,” she added. “Reach out to new Fellows and welcome them.”
Dr. Turner also urged conference attendees to complete their member profiles and to encourage their constituents to do the same. It is her goal to implement “substantive use of existing member data to drive marketing and increase value to our Fellows.” Thousands of patients use the College’s “find-a-surgeon” feature on the website, added Dr. Turner in a post-conference interview, “So, updating one’s profile is a smart business decision as well.”
In his presentation, Christian Shalgian, Director, Division of Advocacy and Health Policy, outlined legislative and regulatory issues that are a priority for the College this year, including Medicare physician payment, quality care initiatives, graduate medical education and workforce challenges, and medical liability reform. Mr. Shalgian called 2013 “the year of less spending” and cited sequestration cuts, less government funding, and budget reductions as examples of this year’s overall economic climate.
“The current system is broken and $138 billion in debt has been created,” noted Mr. Shalgian in reference to the current Medicare physician payment fee schedule. “The first step is eliminating the current system and eliminating the debt. The second step is determining what replaces the current, broken system.” Mr. Shalgian said the sustainable growth rate (SGR) formula, which is used to calculate physician payment, could be replaced with the Value-Based Update, a proposal developed by the ACS that better reflects accurate health care costs and would factor in the quality of care physicians deliver based on measures that are meaningful to both patients and surgeons.
“The College is seen as a group that brings solutions to the table,” added Shalgian, referring to the VBU proposal. “The ACS has developed the framework for this proposal, and now we need to add data and modeling,” he said. Specifically, the College has partnered with researchers from Brigham and Women’s Hospital, Boston, MA, and Brandeis University, Waltham, MA, to gain a better understanding of how this methodology may be used to ensure that payment updates are more closely aligned with factors that surgeons can control rather than being anchored to the spending and resource use of all Medicare Part B providers.
The remainder of Mr. Shalgian’s presentation highlighted strategies for strong advocacy. In particular, he championed grassroots actions as straightforward means of connecting with policymakers on Capitol Hill. “I am often surprised to learn that some really accomplished surgeons are intimidated by the thought of calling Capitol Hill,” observed Mr. Shalgian. “They shouldn’t be. These offices keep track of who is calling and what they are calling about, so it’s important not to worry about who is specifically answering the call. Just make the call.”
Mr. Shalgian also unveiled a new grassroots initiative titled ACS–SurgeonsVoice, which he described as an “ongoing, organized program of recruiting, educating, and motivating members to use their political power to advocate and influence.” The program’s mission, according to Mr. Shalgian, will be to develop a “united surgical voice influencing policy” with participants at all levels including residents, Fellows, and leadership.
Following Mr. Shalgian’s presentation, Dr. Hoyt provided an overview of the ACS Inspiring Quality initiative and ACS NSQIP. “Not only do we have the opportunity to make a difference right now and the professional responsibility to make it happen—I also believe that we really are at a crossroads,” observed Dr. Hoyt in his opening remarks. “What we decide to do in the next few years may have profound effects on the future of our profession. Putting our imprimatur on quality in a very public and recognizable way strikes me as one of the important things we can do not just for our patients and our future Fellows, but for our societal commitment as surgeons.”
He outlined four “guiding principles of continuous quality improvement,” including the following: standards (validated by research and data, nationally benchmarked); infrastructure (including proper staffing levels, checklists, and information technology); rigorous data (including post-discharge tracking and continuously updated, real-time measurement); and verification (external peer-review).
Dr. Hoyt’s presentation also included the official release of a new, limited-edition book titled Inspiring Quality Tour: Lessons Learned in the Pursuit of Quality Surgical Health Care, which summarizes the findings of an 18-month effort to generate a national dialogue about surgical quality and patient safety through a series of ACS Surgical Health Care Quality Forums held throughout the country.
“Failure to take action—whether that failure is born of fear of reprisals or simply apathy born of decades of administrative battles—is actually more pernicious than public ridicule. My message to you today is that we are at a critical time right now when it comes to advocating for the right kind of quality improvement,” Dr. Hoyt said.
The final presentation in the ACS infrastructure session was led by Dr. Napolitano, and provided an overview of the B/G committee reorganization. In particular, she summarized the goals of the board’s five pillars—Member Services, Education, Advocacy/Health Policy, Quality-Research/Optimal Patient Care, and Communication—which are modeled after the Divisions of the College. Workgroups representing each of the pillars are being led by members of the Board of Governors’ Executive Committee to whom the chairs of the workgroups will report.
The Board of Governor “Leads” for each pillar are as follows:
- Member Services Pillar: Lead: Fabrizio Michelassi, MD, FACS
- Education Pillar: Lead: Lorrie Langdale, MD, FACS
- Advocacy and Health Policy Pillar: Lead: Jim Denneny, MD, FACS
- Quality-Research/Optimal Patient Care Pillar: Lead: Sherry Wren, MD, FACS
- Communication Pillar: Lead: Gary Timmerman, MD, FACS
Dr. Napolitano said the goal of the pillars is to allow for closer “alignment and interaction with College activities and divisions.”
Challenges in leadership
The conference’s third session, Challenges in Leadership, included presentations by Mark C. Weissler, MD, FACS, Vice-Chair, Board of Regents; Gary L. Timmerman, MD, FACS, Vice-Chair Board of Governors; and Mary E. Fallat, MD, FACS, Chair, Advisory Council for Pediatric Surgery.
Dr. Weissler opened the session by underscoring the importance of setting goals. It can “sometimes be difficult for a professional organization to maintain a focus, because it is not like a business where goals can be easier to define, goals such as maintaining profit and the creation of new products,” observed Dr. Weissler. “The core purpose of the ACS is to maintain the professional core of surgery in North America,” said Dr. Weissler. He noted that surgery in North America is not only about open abdominal general surgery, but rather, it is about T&As [tonsillectomy and adenoidectomy], cataracts, joint replacements, and sinus surgery. “If we really advocate for the surgical patient we must realize that this is truly who they are,” he said. “Surgery is increasingly subspecialized and if we want to remain the umbrella organization and maintain membership, we must remain inclusive and cater to a variety of needs.” He encouraged attendees to be “visionary versus reactionary. Have a vision for where you want to end up in the future, have a plan for 10 or 20 years from now for what surgery will look like in America.”
In his presentation, Dr. Timmerman championed the new B/G pillar structure, noting that it is designed to “reduce duplication of effort” and provide a unique opportunity for “Governors to contribute to the ACS organization.”
Dr. Timmerman also outlined the qualities of a strong leader. “The best leaders are the best listeners, are humble servants, and [engage in] volunteerism,” said Dr. Timmerman. “Attempt to do something outside your comfort zone,” he added. “It is important to try something new and to use all your resources—no matter who they are, where they are from, or what you may think they have to offer.”
Closing out the session, Dr. Fallat described specific challenges surgeons typically face, particularly those in leadership positions, including “volume of information, time constraints, ability to absorb content, and ability to extract what is important for all surgeons, as well as what is important for the specialty.”
Dr. Fallat discussed the alignment of ACS pillars with pediatric surgery, including the Advocacy and Health Policy Pillar, and she explained how advocacy issues for children can be both similar and different from adult advocacy issues.
The fourth and final session of the Leadership Conference addressed the concept of enhanced member engagement from two perspectives—young surgeons and chapter leaders—and included presentations by S. Rob Todd, MD, FACS, Chair, Member Services Workgroup, Young Fellows Association; Steven L. Chen, MD, FACS, Chair, Education Workgroup, Young Fellows Association; and David W. Dexter, MD, FACS, member, ACS Northwest Pennsylvania Chapter.
Dr. Todd described the advantages of membership in the College for young Fellows, such as the development of leadership skills and the opportunity to convey concerns of young Fellows to ACS leadership, and for ACS leaders, including mentoring future organization leaders and enlisting assistance in activities, particularly at the chapter level.
“We surveyed interested young Fellows from previous meetings representing all surgical specialties,” said Dr. Todd. “Fifty percent of those surveyed are involved in their local chapter, but 82 percent want to be even more involved in the ACS.” He said approximately a dozen local/regional chapters lack a YFA representative and urged young Fellows to get more involved for themselves and the future of the profession.
Dr. Chen highlighted the ACS YFA Mentorship Program as an example of enhanced engagement among young physicians and established surgeons. “Many young Fellows are interested in being more involved in the ACS. Yet, many young Fellows are not sure how to access College leadership,” he added, noting that “many young Fellows lack local mentors that have ACS ties.” Dr. Chen encouraged attendees to apply to become either a mentor or mentee, as both roles can lead to increased involvement with the College. Since the program launched in July 2011, “All but one mentor said they plan to be in touch with their mentee after the program is over,” according to Dr. Chen. “Five mentors felt this improved their own view of young Fellows and their own knowledge of what the ACS has to offer,” he said.
In a presentation titled Best Practices for Your Chapter and Your Members, Dr. Dexter described strategies for stimulating chapter growth and member engagement, including developing a plan for the future, achieving financial stability, providing self-assessment continuing medical education for members’ Maintenance of Certification, and getting residents involved in chapter activities. Successful chapters, he said, “sustain membership, involve and recruit young surgeons, are marked by member enthusiasm, feature strong administrative leadership, and promote ACS programs.”
Several factors are affecting chapters’ financial sustainability, according to Dr. Dexter, including an aging membership, decreases in enrollment, increasing costs, decreasing vendor support, mergers and consolidation of vendors, and others. He urged attendees to “take financial control of your chapter” by increasing recruitment efforts, eliminating non-essential spending, promoting a fixed location for annual chapter meetings, and seeking sponsorships for events.
The Conference concluded with a new, interactive component designed to boost communication among colleagues. Attendees were organized by state or region into separate meeting rooms with the aim of answering three discussion questions. Attendees later reconvened in the main conference room, where a representative from each breakout session presented a brief report.
Participants addressed the following questions in their breakout sessions:
- What one ACS initiative or event can be planned in your area over the next 12 months that will support or enhance the practice, patient care, financial well-being, or engagement of your local surgeons?
- Of what accomplishment by your local community of surgeons are you most proud?
- What topics would you like to see covered at the Leadership Conference next year?
Several common goals emerged from the breakout session reports including:
- Increased communication among chapter members
- More member engagement
- Professional development training
- Leadership skills training
- Bringing the ACS Quality Forum tour to states that have not hosted a forum up to this point
Member Services staff are compiling the information presented in the breakout session reports and will be providing a summary of these presentations later this year.
The next ACS Leadership Conference and Advocacy Summit will take place March 29 to April 1, 2014, in Washington, DC.