Commentary

A Fellowship of Surgeons


 

My proudest moment as a young surgeon occurred on a clear autumn evening in Atlanta in 1980. On that night I donned the black robe and mortarboard for the last time (finally!) and became a Fellow of the American College of Surgeons. My mentors had emphasized during residency that in order to be recognized as a full-fledged surgeon, attaining fellowship in the College was mandatory. During that era, the honor of becoming a Fellow was sufficient reason to make it a young surgeon’s prime goal.

Over the ensuing 32 years, fellowship in the College has meant much more to me and it has served as a key building block in the foundation of my entire professional career. The annual Clinical Congress, state chapter meetings, and participation in numerous ACS committees have afforded me opportunities to interact and learn from fellow surgeons throughout our country and around the world. Many of these interactions have resulted in lifelong friendships that are renewed at least on an annual basis at the fall Congress and at other ACS events.

Early in my career, I participated in many of the College’s educational offerings. The postgraduate courses and symposia significantly extended and refined what I had learned during residency. In more recent years, under the leadership of Dr. Ajit Sachdeva, the Division of Education has kept pace with the times and now provides Fellows the even greater opportunities to improve and cultivate their skills as well as their knowledge.

Later in my career I was able to participate in the genesis of these educational courses and I have had the privilege of teaching a few – the most memorable being the Surgeons as Leaders course. More than 400 surgeons have participated in this course, which was created to provide them with the skills they need to be more effective leaders in their institutions and in the political arena. Involvement in these ACS educational activities – both as a learner and as a teacher – has been a very satisfying and meaningful aspect of my surgical career.

The ACS mantra of "Inspiring Quality" is so appropriate for this year’s celebration because the College has been in the forefront of promoting quality patient care throughout its 100-year history. Soon after its founding in 1913, the College established the Hospital Standards Committee to develop guidelines for hospitals seeking ACS accreditation. The College was the sole agency for accreditation of hospitals until the 1950s, when the ACS joined with the American Medical Association, American Hospital Association, and American College of Physicians to form the Joint Commission on Accreditation of Hospitals (now The Joint Commission).

The College went on to establish the Committee on Trauma (COT), which set out criteria for accreditation of trauma centers. This program has led to marked improvements in the level of care that trauma patients receive throughout the United States. The COT also established the Advanced Trauma Life Support® (ATLS®) course, which has been presented to thousands of medical professionals throughout the world, saving an untold number of lives.

Most recently, the ACS took responsibility for moving a Veterans Affairs surgical quality improvement program into the private sector. The College’s National Surgical Quality Improvement Program (ACS NSQIP®) is now in place at nearly 500 hospitals of all sizes. It is gaining widespread recognition among health care policy makers as the most effective program for measuring outcomes of care because of its use of risk-adjusted clinical data rather than claims data. Furthermore, evidence is rapidly accumulating that surgical care is significantly improved in those institutions that adopt this program. This initiative is in perfect alignment with the ongoing governmental reforms of the nation’s health care system, and surgeons can proudly claim it as their own.

The government’s involvement in health care started to increase in the 1980s as health care spending started to consume a significant portion of the federal budget. C. Rollins "Rollo" Hanlon, M.D., FACS, recognized the potential effects of government intervention on patient care and established the College’s Washington Office during his term as ACS Director. The capabilities and functions of this office have grown considerably since then under the leadership of subsequent Executive Directors, including Paul Ebert, M.D., FACS, Tom Russell, M.D., FACS, and David B. Hoyt, M.D., FACS. Although progress is not always easily measured in the complex world of political advocacy, surgery’s voice has been heard and has positively influenced national legislation. It is vital that all surgeons, regardless of specialty, support this aspect of the College’s work.

So happy birthday, ACS! I am extremely proud and gratified to have been part of you for nearly a third of your 100-year history. Much has been accomplished, but there is much more to do – especially during the next decade or so as our health care system goes through a major overhaul. Being true to your long-standing principle of promoting patient-centered, quality surgical care, I am certain you will be up to the challenge.

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