Looking forward – November 2021

David B. Hoyt, MD, FACSAt the October meeting of the Board of Regents, I submitted my 12th and final report on the activities of the American College of Surgeons (ACS). Following is a summary of that report. The full report is available here.

Advocacy and Health Policy

The ACS Division of Advocacy and Health (DAHP) has strengthened its credibility and effectiveness in the last year. According to focus group studies conducted by Ballast Research, policymakers credited the College’s lobbyists and consistent grassroots engagement to connect with them at the local level.

A recent report from the National Academies of Sciences, Engineering, and Medicine calls on government-funded health plans (Medicare and Medicaid) to shift money to primary care—a common theme on Capitol Hill. Legislation introduced in the U.S. House of Representatives, for example, would increase Medicaid rates to Medicare rates only for primary care physicians. Consequently, the Surgical Care Coalition (SCC), composed of 13 surgical organizations led by the ACS and the Brunswick Group, has shifted its messaging to emphasize the integral role of surgeons in protecting patients and saving lives. Surgeons face up to a 9 percent payment cut in 2022.

In addition to raising nearly $200,000 from more than 380 ACS members and staff, the ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC) disbursed $171,000 to more than 60 congressional candidates, political campaign committees, and other PACs.


The Division of Education continues to establish benchmarks and to steer national strategic directions in surgical education, training, validation, credentialing, and accreditation. For a complete update, see the full report cited previously.

A key activity over the last few years has been the development of a new manual, Optimal Resources for Surgical Education and Training, also known as the “Gold Book.” Optimal Resources for Education and Training was conceived as a guide for training surgical residents and fellows in an era of work-hour restrictions and increasing administrative burdens. Surgical education is a shared responsibility distributed between the boards, the Accreditation Council for Graduate Medical Education and the Residency Committees, and the professional societies, including the ACS. After many attempts in the last decade to “Fix the Five,” the College recognized that restarting the process by coming to an agreement on the optimal resources for surgical training was needed. This work puts forth an attempt to define the best way to evaluate and think about surgical training going forward. The Gold Book will be published this fall.

Member Services

The ACS has more than 88,000 members, including, as of press time, 68,860 Fellows: 58,209 U.S., 1,290 Canadian, and 9,361 International. The ACS achieved a record number of Initiates in 2021. Applications for 2022 are on track to exceed our 2021 numbers.

All ACS chapters are required to complete an Annual Report of activities during the previous year. Chapter Services received responses from all domestic and international chapters for the fourth year in a row. Based on the data collected from the Annual Reports, Chapter Services continues to clarify chapter expectations and requirements, works with chapters to define their value proposition, and develops marketing tools and templates to enhance member communications.

The ACS has 293 Governors: 154 Governors at-Large representing each U.S. state and Canadian province and territory, 88 specialty society Governors, and 51 international Governors.

The ACS has continued to garner significant press coverage. The ACS has captured 139,200 media mentions since January 1, for a total potential audience reach of 5.9 billion media impressions. Several press outlets now rely on us for repeat coverage of surgical issues.

In 2020, the Board of Governors (B/G) Diversity Pillar was established to collaborate with the existing five B/G Pillars to identify opportunities to promote diversity, equity, inclusion (DEI), and anti-racism.

The College has 14 Advisory Councils, representing each surgical specialty. An Advisory Council Engagement Plan has been developed to maximize Advisory Council involvement in recruitment, retention, and engagement efforts.

This year, the ACS Resident and Associate Society partnered with the Association of Women Surgeons to host a Tweetchat in late June to welcome new interns and offer advice for navigating the challenges of internship.

A call for applicants and selection process was held to identify resident members for a team to support the Rwandan Ministry of Health in strengthening trauma systems in Kigali. With the ACS Committee on Trauma (COT) and Operation Giving Back (OGB), the team will assist with emergency care system assessment, development of action priorities, support for strategic implementation, and coordination of stakeholders.

OGB was integral in establishing the inaugural ACS-COSECSA (College of Surgeons of East, Central and Southern Africa) Surgical Training Hub at Hawassa University in Ethiopia. In total, 28 U.S. surgeons from the consortium surgical departments have dedicated more than $440,000 worth of hours volunteering onsite. Five training courses were administered, and several activities were implemented.

As the work at Hawassa University continued, we also were successful in establishing a second surgical training hub in Zambia. We plan to begin traveling to the site by January 2022 and have engaged all parties in virtual educational opportunities and a virtual needs assessment approach in the meantime.

Over the last several years, a combined effort involving military and civilian surgeons, the Military Health Services Surgery Partnership-ACS (MHSSP-ACS), has developed a blueprint of knowledge points and skill sets essential for the expeditionary surgeon deploying to a military base. The resulting knowledge test has been delivered to 123 military general surgeons over the past year. A similar process was used to develop a blueprint for a deploying military trauma surgeon who must be capable of performing reparative surgery.

The ACS has more than 88,000 members, including, as of press time, 68,860 Fellows: 58,209 U.S., 1,290 Canadian, and 9,361 International. The ACS achieved a record number of Initiates in 2021. Applications for 2022 are on track to exceed our 2021 numbers.

The Mission Zero Act (H.R. 880/S. 1022), passed in 2019, has received appropriations from the House and is awaiting the same in the Senate. Mission Zero Act funds are designated to fund military-civilian partnerships that meet the criteria outlined in the ACS Blue Book, available here.

The Women in Surgery Committee (WiSC) presented the Dr. Mary Edwards Walker Inspiring Women in Surgery Award to M. Margaret “Peggy” Knudson, professor of surgery, University of California San Francisco; adjunct professor, Uniformed Services University; and Medical Director, MHSSP-ACS.

The Intimate Partner Violence Task Force’s accomplishments in 2020–2021 include publishing three articles in the October 2020 issue of the ACS Bulletin, raising awareness of this issue and timed to appear during Domestic Violence Awareness month; presenting the Panel Session Impact of the COVID-19 (coronavirus 2019) Pandemic on Intimate Partner Violence during the virtual Clinical Congress 2020; and a Panel Session, Intimate Partner Violence—What Every Surgeon Should Know during the virtual Clinical Congress 2021.

The International Relations Committee is partnering with the WiSC to create resources that support the HeForShe initiative, promote gender equity at institutions and programs domestically and internationally, and provide practical ways programs can support women surgeons throughout their career and in leadership roles within the ACS.

The IRC partnered with the Governors on a formal framework for observership opportunities for international scholarship recipients and supported the administration of two new ACS scholarships.

The first virtual ACS Leadership & Advocacy Summit was conducted May 15–17, 2021. More than 1,400 domestic and international surgeons, residents, and medical students registered for the Leadership Summit, which provided participants with the opportunity to develop and enhance skills and best practices that they could implement within their practices and institutions.

More than 700 domestic surgeons and surgery trainees registered for the Advocacy Summit, which featured several health care experts and congressional speakers, plus panel sessions focused on ACS health policy priorities.

Research and Optimal Patient Care

The ACS completed 18 months of pilot site visits at hospitals interested in helping us to advance the Quality Verification Program (QVP) and is launching the program nationwide. The ACS QVP is based on Optimal Resources for Surgical Quality and Safety, also known as the Red Book. The ACS QVP takes core elements of the Red Book to establish standards and a process for verification that aims to create a surgical quality program that improves efficiency, care, and value for all surgical patients across all divisions of surgery within the hospital. We also conducted pilot site visits for rural, vascular, thoracic, emergency general surgery, and complex gastrointestinal surgery.

A new ACS Quality Improvement (QI) Course: The Basics has been developed and is intended for the surgical workforce and other QI hospital staff.

In response to the limited ability to hold live courses during the pandemic, trauma education collaborated with COT leadership and global course sites to focus on online training to extend Advanced Trauma Life Support® (ATLS®) providers’ status by one year, remote/online proctoring of courses, distribution of the ninth edition of the MyATLS mobile application, and free access to select components of the MyATLS course and Advanced Surgical Skills for Exposure in Trauma (ASSET) course videos.

The second edition of ASSET launched in February 2021, offering expanded content and the option for two-day ASSET+ training targeted at military providers to prepare for deployment.

The third edition of the Advanced Trauma Operative Management student textbook and live training course will roll out to course sites this year to reflect the latest in evidence-based practice and offers enhanced operative management algorithms, expanded chapter content, and a new online management system.

A new Advanced Disaster Medical Response program will launch this year to train multidisciplinary medical disaster response personnel in the foundations of basic medical and public health disaster care, medical response to terrorism, weapons of mass destruction, specific injuries, and special considerations, such as psychological response to disasters.

STOP THE BLEED® (STB) now has 91,964 instructors and has trained nearly 1.8 million people worldwide in bleeding control. STB has partnered with Amazon to implement STB training throughout warehouses in Canada and the U.S. and is piloting STB training with Lewis Tree Company in Connecticut, Maryland, and Florida.

The Future Trauma Leaders 100 program was revived before the COT’s Annual Meeting in March.

ACS Cancer Programs continue to meet 2021 strategic goals, innovate to deliver on the promise of new products and services, adapt to challenges associated with the pandemic, and prepare for the 100-year anniversary of the Commission on Cancer (CoC). In addition, Cancer Programs made progress on long-term sustainability goals, including driving QI, and strengthening inter-programmatic integrations.

Cancer accreditation programs include the CoC, National Accreditation Program for Breast Centers, and National Accreditation Program for Rectal Cancer. These teams quickly adopted virtual site visits and virtual site visit training, completing approximately 500 virtual site visits and training 120 site visitors.

Staff, members, and leaders have been working on building content for the ACS website, the Bulletin, and other communications vehicles to celebrate the 100-year anniversary of the CoC, including articles on the CoC’s leaders, achievements, contributions, and value.

Integrated Communications

The Division of Integrated Communications has undergone significant changes in recent years and continues to evolve as technology and leadership changes. A multifaceted communications campaign is under way to persuade Congress to stop the payment cuts described previously.

The ACS has continued to garner significant press coverage. The ACS has captured 139,200 media mentions since January 1, for a total potential audience reach of 5.9 billion media impressions. Several press outlets now rely on us for repeat coverage of surgical issues.

National STOP THE BLEED® Day and Month primarily were observed remotely this year. In partnership with the STB team, the College reached out to STB State Champions and recorded their comments about why STB is important in their communities.

The ACS has continued to garner significant press coverage. The ACS has captured 139,200 media mentions since January 1, for a total potential audience reach of 5.9 billion media impressions. Several press outlets now rely on us for repeat coverage of surgical issues.

The ACS selected Hugo & Cat, a digital agency, in August 2020 to develop the new facs.org site and to partner with the ACS on a refreshed digital strategy. Hugo & Cat has been working with the ACS to develop a new, state-of-the-art website. The site will launch in January 2022.

The Journal of the American College of Surgeons (JACS) impact factor improved this year, from 4.59 to 6.113, which represents an increase of approximately 33 percent. JACS now ranks ninth out of 270 in the surgical journals category. Beginning January 2022, JACS will have a new publisher, which will focus on expanding global readership.

During the pandemic, the College replaced its weekly newsletter, ACS NewsScope, with the Bulletin Brief, which has average open and click-through rates above the industry standards.

The monthly Bulletin maintains its identity as the College’s publication of record. Most members read the Bulletin online, but approximately 4,500 read the print edition. A monthly e-mail alerting members that the Bulletin has been posted online continues to garner open rates of approximately 27 percent.

The creative group has been reconfigured to ensure more coordination and collaboration between the design, video production, project management, digital strategy, and digital and social media teams. The creative group worked closely with Weber Shandwick on an initiative to create, refine, and test a new ACS logo and color palette.


The Regental Committee on Anti-Racism convened a virtual event, Promoting DEI & Anti-Racism: Professional Surgical Society Retreat, in June 2021. More than 170 individuals, including surgeons and leaders from professional surgical societies, ACS Officers and the Board of Regents, surgical organization leaders, ACS Advisory Council Chairs, and surgical board representatives, participated.

To address racial issues and opportunities as they pertain to the increasingly diverse ACS staff, the College developed START (Staff Addressing Racism Task Force). Additionally, the ACS Staff Office of Diversity has been established under the leadership of Cie Armstead, MPA, DBA.

ACS Foundation

Fiscal year 2021 ended with $2,618,553 in donations and grant support. Individual donations totaling $356,918 supported the Greatest Needs Fund, with $200,000 of those monies directed toward scholarships. Programs, projects, and initiatives received $2,185,617.

THRIVE Initiative

The ACS and the Harvard Business School’s Institute for Strategy and Competitiveness have partnered to form ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency) to help hospitals and surgical practices improve surgical patient outcomes while lowering the cost of delivering care.

The THRIVE team has worked virtually with hospitals in the U.S. and Australia, completing six colon surgery studies, six bariatric surgery studies, two lumpectomy studies, and one study on mastectomy with reconstruction.


It has been my privilege to serve as the Executive Director of the ACS for the last 12 years.

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