Looking forward – January 2014

David B. Hoyt, MD, FACS

At press time, the nation was both reflecting on the 50-year anniversary of the assassination of U.S. President John F. Kennedy and preparing for the holiday season. These two contrasting events reminded me that over the last 50 years, all Americans, particularly surgeons, have borne witness to many profound changes in our society and our profession—some more positive than others.

A fateful day

I was a 14-year-old high school freshman the day President Kennedy was assassinated. Like most young people of the time, I felt a connection to the youthful president and his wife, and his steadfast efforts to deal with the difficult issues of the day were inspiring.

The early 1960s were a precarious time in U.S. history. The climate of confrontation with communism, the vulnerability of the world to nuclear destruction as evidenced in the proliferation of bomb shelters both in people’s homes and at schools, and the rising awareness of racial inequities created a strong sense of fear among many Americans.

During his short time in office, however, President Kennedy generated a feeling of optimism and confidence about the future. He took on the Cold War with strength and resolve, established the Peace Corps, and shared his vision of excellence and innovation in science, space exploration, medicine, human rights, and racial and gender equality. And, with his beautiful and intelligent wife and children, the Kennedy White House emanated a touch of class and vigor.

His assassination in November 1963 seemingly put an end to much of the national enthusiasm, and the country’s mood took a rather dark turn. The war in Vietnam escalated over the coming years, and, in response, the size, number, and volatility of anti-war protests grew. Although Kennedy’s successor, Lyndon B. Johnson, signed the Civil Rights Act, frustrations over ongoing racial disparities erupted into inner-city riots. In the 1970s, the revelations in the Pentagon Papers followed by Watergate during the Nixon Administration left many Americans feeling betrayed and distrustful of politicians.

Progress continues

Even during those tumultuous days in the nation’s history, however, much progress occurred, particularly in medicine. Technological and scientific advances in angiography, ultrasound, magnetic resonance imaging, computed tomography, and so on have led to more accurate and speedier diagnoses. Innovative surgical techniques, including endovascular, laparoscopic, and robot-assisted procedures, have led to safer operations with shorter recovery times.

Furthermore, in the last 50 years, we have witnessed the development of acute care and trauma systems, multidisciplinary teams for cancer care, the rise of transplant surgery, and advances in every surgical specialty. As a result, many more critically injured and ill patients have a far greater chance of leading long and productive lives.

Outside of surgery, the nation and the rest of the world have benefitted from other technological innovations—many of which have evolved directly or indirectly through the fulfillment of President Kennedy’s vision of landing on the moon and exploring the rest of the galaxy. Examples include computerization and electronic and digital communication. Indeed, 50 years ago, few among us would have imagined the swift and wide-ranging effects of modern technology on nearly every aspect of our day-to-day existence.

Continued uncertainty

Nonetheless, numerous issues continue to confront the world, many of which cannot be resolved with technology alone. To overcome these challenges, we must call upon not only our ingenuity, but also our past experience and collective wisdom.

Examples of high-priority issues in surgery include access to and ongoing disparities in health care, outside interference with the surgical practice environment, and economic concerns. Many surgeons also have concerns regarding how they will be evaluated professionally as the nation moves toward a value-based health care system. Who will decide whether they are providing quality care and how they will be paid? What new regulatory burdens will they face in their efforts to provide accountable, reliable, transparent, patient-centered care? Will their efforts to maintain certification and licensure detract from their time in the operating room and consulting with patients?

Unquestionably, our profession faces many challenges, and, yes, we live in a time of great uncertainty. But as I look back on the last 50 years and recall walking home from school on a cold, rainy November afternoon in Hudson, OH, I am reminded that these difficulties are relatively small, albeit significant, in comparison with what the nation was experiencing at that moment.

Looking forward

The American College of Surgeons (ACS) is working hard to help its members meet these evolving demands and to ensure that surgeons are involved in setting the standards for the profession. In the process, we would be wise to draw on the values, inspiration, and leadership that President Kennedy demonstrated during his brief time in office. We must look to the future not with fear and cynicism, but with a commitment to continuing to make progress in the delivery of quality care and to building on the legacy of those innovators who came before us. And as we begin 2014, to paraphrase President Kennedy, I would ask each of you to ask not what your profession can do for you, but what you can do for your profession.

I look forward to working with all of you and am committed to ensuring that the ACS will continue to meet your expectations and the needs of your patients. Thank you for the privilege of serving as one of the leaders of this organization, and happy New Year.

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