The American College of Surgeons: Challenges for the Second Century



As the American College of Surgeons enters its second century, the challenge before us is to uphold the traditions and values of the past while embracing the future with enthusiasm.

The ACS Board of Governors, which represents the broad constituencies of the College, uses the term “pillars” to define the College’s core activities. Although these areas of focus will likely change in time, I would like to offer some thoughts regarding the current pillars and likely future challenges for each.


The College leadership is sensitive and responsive to the concerns and desires of Fellows; however, some members maintain that the leadership isn’t aware of what they are experiencing in practice. To eliminate this disconnect, Fellows should take advantage of some of the communications vehicles that the College now offers to encourage interaction between the Fellows and the leadership.

Dr. J. David Richardson

Dr. J. David Richardson

We now have more than 100 online “Communities” that allow members to engage in real-time discussions issues of mutual interest. Embrace your specialty’s Community and become enmeshed in conversations about advocacy, rural surgery, international surgery, and so on. ACS leaders are active in these Communities and pay attention to the concerns raised in these forums.

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At the 2015 ACS Leadership & Advocacy Summit, retired U.S. Army General Stanley McChrystal offered his perspective on leadership. One theme he articulated is that leaders should actively engage with the rank-and-file troops. Building on that viewpoint, I would opine that for the ACS to succeed, we need the active and sustained engagement of our surgeons in the field.

Indeed, it has been the College’s experience that these members are the innovators who move the organization forward. For example, the Advanced Trauma Life Support® program is one of the most successful programs in ACS history. This course wasn’t a pipe dream of a regent; rather it was developed by surgeons in Nebraska who saw a need and acted on it. Similarly, the women and men practicing in rural areas created an Advisory Council for Rural Surgery and the online Rural Surgery Community to address the concerns of individuals who practice in nonmetropolitan areas.

For young Fellows, local involvement may be an ideal starting point. Many ACS chapters are floundering and need the energy and creativity young Fellows bring to the table.


Setting the standards for the delivery of quality surgical care was a core objective of the College’s founders, and quality improvement (QI) remains a primary mission. Although most surgeons are committed to providing high-quality care, they are less likely to participate in QI programs at their institutions.

Quality, which will be increasingly data and outcomes driven, is the benchmark by which future surgeons will be judged. Surgeons must own quality. Its measurement must be local, personal, accurate, and risk adjusted.

Recognizing that if surgeons don’t take ownership of this space, someone else will, the ACS has invested millions of dollars in QI programs – including the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and “QIPs” for trauma, cancer, and bariatric surgery. However, surgeons and their institutions must use them if they are to have a meaningful effect on patient care. If your hospital can’t afford to participate in ACS NSQIP, find a partner, build a consortium or cooperative, or create your own QI measurement tool. Specialty societies have registries that you can tap. One way or another, though, tomorrow’s surgeons will need a record of all cases and outcomes and a means to critically evaluate their performance.


Since the first Clinical Congress more than 100 years ago, education has been the heart of all College efforts. The ACS now offers educational activities programs for surgeons at all levels, but mostly continuing education for practicing surgeons while other groups have assumed control over residency training. In my opinion, the greatest threat to the provision of quality surgical care in the future is the erosion of core surgical training.

I have spent 18 years as a general surgery residency program director; 7 years on the American Board of Surgery, including 1 as chair; and 7 years on the Residency Review Committee for Surgery, including 1 as vice-chair. These experiences have convinced me that future ACS leaders should demand radical changes in surgical training paradigms.

Undoubtedly, any attempt to fundamentally change training will be met with resistance from organizations currently in control. We should engage these bodies in a cooperative spirit; however, real solutions may require a surgical approach – a thoughtful, calculated plan that can be executed decisively.

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