For all those who say that the surgeon in the trenches doesn’t have a voice in the world of organized surgery, I have a story or two for you.
About 10 or more years ago, I was at a lovely old hotel in Cooperstown, N.Y., listening to a group of elder rural surgery colleagues hold forth about feeling ignored by the American College of Surgeons and how we should all band together to form a new society of rural surgeons. Like most crowds, they were getting pretty worked up. They were pretty sure such a revolution would solve our problems and we would quit being the Rodney Dangerfields of surgery (not getting any respect, as the great comic used to say).
It took a while – a few years – for the rural surgeons and ACS leadership to get to know each other better. We did, however, get there. An Advisory Council was created with the help of some very heavy hitters not often regarded as rural champions, most of whom had roots in the rural world that helped them understand what this group of surgeons wanted and needed.
Not too much removed from this event, many surgeons were feeling isolated in general due to the many challenges of rural practice familiar to so many of us. ACS leadership sensed that surgeons needed to be connected and with considerable effort they formed listservs and found that they were successful to some degree. So, under Dr. David Hoyt’s guidance a better technology was found, resources were committed, and the ACS Communities was launched. A new era in surgeon-to-surgeon and surgeon-to-leadership communication was born. It was as if we had developed talk radio for surgeons. Some stations were loud, others came in rather softly, but all were on the air. The pulse of the Fellows became audible.
Almost simultaneously, dissatisfaction with Maintenance of Certification grew as surgeons in practice began reaching their second and third recertification and the practice of surgery became ever more specialized. Many surgeons believed that nothing would ever change, that the front-line surgeon didn’t have a chance to affect change, and that the big dogs wouldn’t listen. But the College leadership heard the voices of concern and took steps to support a new approach to certification.
So here we are in 2017, coming off a very successful Clinical Congress. The formerly obscure rural surgeon contingent had several panels on the program. Surgeons practicing in towns as small as 3,000 moderated sessions. Some of those sessions were standing room only. The College assisted (and had for a few years) those rural surgeons in organizing a Rural Surgery Dinner, which filled a restaurant full of surgeons delighted to meet in person surgeons from small communities all over the country. They shared their common experiences and planned for a better tomorrow. Later in the week, the 2nd Vice President-Elect was announced. He is a surgeon from Keokuk, IA, and one of the leaders of the rural surgeon movement within the College, Philip Caropreso, MD, FACS. A new Regent was announced: Gary Timmerman, MD, FACS. Dr. Timmerman started his career in Watertown, S.D., and now runs a rural-based surgery training program.
The Clinical Congress program included many topics and issues that Fellows from every branch of surgery had posted about on the ACS Communities. The American Board of Surgery announced sweeping coming changes to help surgeons move on from an MOC system no one was really happy with to one that has great hope of making ongoing certification more than a hoop to jump through, but instead, a real value to the Diplomate. Sitting on the main committee for the American Board of Surgery’s sprint team on certification is a surgeon from Crockett, Texas, Pat Walker, MD, FACS, who practiced surgery “on the ground” in a small community setting for three decades.
Most of us would agree that rural surgeons are facing truly daunting professional headwinds, despite their critical work in serving rural patients. Yet I have been gladdened at the response and respect that the College leadership has given to rural surgeons in recent years. The outreach by the College to support rural surgeons is part of a broader effort to hear every Fellow and make the College more relevant in the life of hard-working surgeons of every type. Changes in how we retain and improve our certification process in some significant ways came out of College efforts to listen and respond to the concerns of Fellows in the College. These and other initiatives by the College leadership show a degree of farsightedness and caring that should be gratifying to all Fellows.
When Lindsay Fox, MD, FACS, a young rural surgeon in private practice with an 8-week-old baby, receives an award for excellence, moderates her panel at the Clinical Congress to a standing-room-only crowd, and then shares her experience through the Communities, I’d say the American College of Surgeons has done an amazing job in a short period of time to make our organization reflect all of us. As Mel Allen, the voice of the Yankees in their heyday, would say, “How about that!”
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.