Commentary: ACS continues to support surgeons in training and in practice



It is once again my privilege to provide ACS Surgery News readers with an update on the activities of the American College of Surgeons (ACS). Each year the scope of the College’s projects as described in this missive continues to expand as the ACS leadership and staff strive to meet our members’ evolving demands.

FIRST things first

A highlight from this last year has been the College’s participation in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. As members of an organization founded largely for purposes of ensuring that surgeons are adequately trained to provide quality care, many ACS Fellows have expressed concern about the structure of today’s surgical residency programs. They are particularly concerned about the effects of the residency work hour restrictions that the Accreditation Council for Graduate Medical Education (ACGME) issued in 2003 and 2011.

Dr. David B. Hoyt

Dr. David B. Hoyt

The ACS, the American Board of Surgery, and ACGME sponsored the FIRST Trial to determine whether modified restrictions on resident work hours would affect patient care, surgical outcomes, and resident perceptions. Karl Y. Bilimoria, MD, MS, FACS, ACS Faculty Scholar and director, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL, led the study, which involved 117 ACGME-approved U.S. general surgery residency programs and their 151 affiliated hospitals. These institutions were randomly assigned to either an intervention group with flexible duty hours or a control group.

For both groups the workweek was limited to an average of 80 hours, residents averaged one day off per week, and residents could take call no more than every third night. The standard policy group, composed of 59 training programs and 71 affiliated hospitals, also complied with the ACGME’s other mandates, whereas the 58 training programs and 80 affiliate hospitals in the flexible policy group received permission from the ACGME to waive some of the restrictions on maximum shift lengths and time off between shifts.

Using the ACS National Surgical Quality Improvement Program (ACS NSQIP®) platform to measure death or serious morbidity within 30 days of an operation, the FIRST Trial showed that of the nearly 139,000 patients treated, the rate of this composite outcome was similar in both study groups (9 percent). We also found no group differences for 10 other patient outcomes, including the need for a second operation. Moreover, residents in the flexible policy group were more likely than were participants in the standard policy group to report improved continuity of patient care, acquisition of operative skills, and levels of professionalism.

Results of the FIRST Trial were published in the New England Journal of Medicine and announced at the Academic Surgical Congress last month. In light of the study’s findings, the ACGME has agreed to review its work hour policies. I am confident that the ACS, ABS, and ACGME will be able to use this initiative to develop new consensus-based protocols for resident work hours.

Other ACS initiatives

The FIRST Trial is just one important initiative that the College has undertaken recently. We remained active on the advocacy front, working closely with Congress and other physician groups to achieve passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This important legislation repeals the sustainable growth rate Medicare physician payment formula, establishes an annual payment update of 0.5 percent for five years, and seeks to establish a Merit-Based Incentive Payment System. The College also issued public comments on physician rating systems, questioning the usefulness of information that is based on administrative rather than clinical data.

In terms of practice management, the College has provided resources and information to help surgeons make the transition to the 10th revision of the International Classification of Diseases coding system (ICD-10). We also have continued to sponsor Current Procedural Terminology coding workshops and to offer access to the ACS Coding Hotline.

To ensure that all patients have access to quality care, the ACS Committee on Health Care Disparities established a relationship with National Institute on Minority Health and Health Disparities and conducted a symposium in May 2015 to address variations in care across all patient populations.

Through involvement with the Hartford Consensus, chaired by ACS Regent Lenworth Jacobs, MD, FACS, the College has sought to ensure that victims of mass casualty events receive timely lifesaving care. This past year, the Hartford Consensus joined forces with the White House to publish a compendium of strategies to enhance survival in mass casualty events and ensure the public understands how to assist victims of these tragic incidents.

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