Surgeons Bring Their Case to Capitol Hill at 2026 Advocacy Summit

Surgeon advocacy has always mattered. But with consequential policy conversations underway on everything from reimbursement and workforce shortages to rural access and administrative burden, the call for showing up in Washington has rarely felt more compelling or more timely.

ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS, and Christian Shalgian, Senior Vice President of the ACS Division of Advocacy and Health Policy, welcomed more than 340 attendees to the Advocacy portion of the 2026 ACS Leadership & Advocacy Summit, held February 28–March 3, at the Grand Hyatt Washington Hotel in Washington, DC.

The Advocacy Summit offers attendees the opportunity to spend a day in the room with the people who know these issues best—policy experts, healthcare researchers, and seasoned advocates—working through the substance and strategy behind each congressional ask, culminating with in-person visits on Capitol Hill.

“This is a pivotal moment for surgery. Decisions being made in Washington right now will shape who can access care, how surgeons are paid, and whether our workforce is sustainable for the next generation. If surgeons aren’t at the table, those decisions will be made without us,” said Shalgian.

Rural Surgery: Challenge, Opportunity, and “Gold Mine”

The morning panel "Advocating for Rural Surgery: Evaluating Workforce Shortages" set the tone for the day, taking on one of the most stubborn structural challenges in American healthcare—the surgical desert.

Moderated by ACS Regent Gary Timmerman, MD, FACS, from the University of South Dakota Sanford School of Medicine in Vermillion, the session brought together a panel with a deliberately varied geography—academic medical centers, community hospitals, rural health systems—to examine the workforce gaps that leave millions of Americans without reliable access to surgical care.

More than 20% of the US population lives in rural or frontier locations, with less than 10% of the healthcare workforce practicing in the same regions (even fewer general surgeons), according to Dr. Timmerman, who added, “The workforce is not just small. It is aging, unevenly distributed, and not being replenished at adequate rates.”

The numbers are not new, but they remain striking.

Surgeon shortages in rural areas are projected to worsen as the current workforce ages, training pipelines fail to redirect graduates toward underserved communities, and reimbursement structures continue to disadvantage lower-volume, higher-overhead rural practices.

Panelists Waddah B. Al-Refaie, MD, FACS, from Creighton University in Omaha, Nebraska, Estin Yang, MD, MPH, FACS, from Oregon Health & Science University in Portland, Daniel Chase, MD, FACS, from the University of Illinois College of Medicine at Urbana-Champaign, and Thomas Tsai, MD, MPH, FACS, ACS Medical Director of Health Policy Research, examined what policy levers exist to address this and how surgeons effectively can make the case to legislators who represent rural constituents but may not fully grasp what surgical access means for them.

Dr. Al-Refaie framed rural surgery as both a challenge and an opportunity, describing it as a “gold mine” for innovation and policy transformation. Through state-supported research initiatives and partnerships with the ACS, his team is developing a rural surgery–centric research framework focused on access, quality, workforce drivers, and equity. He emphasized that geography matters deeply and cautioned that “one solution doesn’t fit every rural place,” calling for tailored strategies grounded in data.

Building on that foundation, Dr. Yang, a practicing rural surgeon and representative of the North American Rural Surgical Society, highlighted workforce realities on the ground. Despite growth in rural training rotations, only about 6% of general surgery graduates ultimately practice in rural communities. Isolation (professional and social) remains a powerful deterrent.

“Looking forward, we find that the number of urban general surgeons will grow in tandem with the population growth, leading to a slight oversupply of general surgeons in urban areas, whereas in rural areas, we expect that growth to continue to stagnate and lead to a roughly 60% deficit. What we’re doing works to some degree, but it isn’t enough,” he noted, urging stronger mentorship, clearer definitions of rural practice, and better retention strategies.

Dr. Chase, who is a member of the ACS Advisory Council for Rural Surgery, guided the discussion squarely into day-to-day practice. Rural surgeons, he explained, operate across an unusually broad scope—providing endoscopy (30–45% of the practice), emergency surgery, trauma care, and often filling gaps left by absent subspecialists. In many communities, they are the backbone of the hospital’s viability. However, increasing hospital consolidation means rural facilities are often managed by distant systems unfamiliar with local realities.

“You're at the mercy of someone 200 miles away who has no idea what your rural practice is like, what your population is like, and how care is delivered in your community,” he said.

Closing the discussion, Dr. Tsai focused on the evidence needed to drive policy change. He described efforts to modernize surgical staffing capacity mapping through interactive, data-driven tools that track surgeon supply at the county and referral-region levels. His team also is using machine learning to define surgeons by actual practice patterns rather than training labels, revealing geographic and subspecialty maldistribution.

With projections showing significant shortages of surgical specialists in the coming decade, Dr. Tsai emphasized that sustainable solutions must be grounded in rigorous data. Evidence, he explained, is essential to inform reimbursement reform, graduate medical education expansion, and federal workforce legislation. “We can’t solve maldistribution until we solve the supply problem,” he said.

“The panel with Dr. Timmerman evaluated current and future workforce shortages in surgery and made a cogent argument for the need to expand access to rural surgery to sustain growth in the surgical workforce,” said attendee Arun K. Gosain, MD, FACS, ACS Regent from Ann & Robert H. Lurie Children's Hospital of Chicago in Illinois. “This message helped us to better understand the often-conflicting arguments made for growth in primary care at the expense of growth in surgery.” 

Fee Schedule Fight

If the rural workforce session was about access, the next panel was about economics—and the two are not unrelated.

The session "Surgery vs. Primary Care: A False Dichotomy Built into the Fee Schedule" featured Christopher Childers, MD, PhD, from the University of Washington in Seattle, Jose Figueroa, MD, MPH, from Harvard T. H. Chan School of Public Health in Boston, Massachusetts, and health economist Irene Papanicolas, PhD, from the Brown School of Public Health in Providence, Rhode Island, who took apart the assumptions baked into how surgical work is valued under the Medicare Physician Fee Schedule.

Dr. Childers unpacked the mechanics of the fee schedule and how its structure fuels the perceived conflict between primary and specialty care. Under long-standing budget neutrality rules, any significant increase in payment for one set of services must be offset by reductions elsewhere.

In recent years, conversion factor cuts, efficiency adjustments, and Centers for Medicare & Medicaid Services decisions not to update global surgical codes have effectively redirected billions from procedural specialties. The prevailing policy narrative, he noted, assumes that increasing primary care reimbursement will automatically improve national health. Dr. Childers urged attendees to scrutinize that assumption by asking a more fundamental question: what does the evidence actually show about how health outcomes improve?

That question set the stage for Dr. Figueroa, who examined national outcomes data to test whether the payment debate aligns with the realities of population health. Avoidable mortality has worsened in every US state over the past decade, driven largely by external causes, such as drugs, suicide, homicide, and traffic injuries—as well as cardiovascular disease.

At the same time, the US performs strongly on cancer screening, vaccination, and chronic disease management. The implication, he argued, is that the core drivers of premature death lie largely outside the clinical encounter and beyond the payment of any single specialty.

“Even though we have strong performance within the healthcare system, it is not enough to protect us,” he said.

Extending the discussion to spending patterns, Dr. Papanicolas examined whether over-specialization explains higher US costs. It does not. The physician workforce mix resembles that of peer nations, and primary and specialty care operate as complements, not substitutes. Instead, administrative complexity and high prices—particularly nonclinical costs—distinguish US healthcare spending. Together, the panel concluded, meaningful reform must be grounded in evidence, not false dichotomies.

“For years, I’ve attended the ACS Leadership & Advocacy Summit, and I’ve never been more encouraged than I am now. The conversation is shifting in a meaningful way—ACS quality data are strengthening our message and helping us clearly demonstrate the value of surgery. In a healthcare environment where financial pressure often pits specialties against one another, surgeons finally have the tools to show—not just say—why our work matters,” said attendee Don J. Selzer, MD, MBA, FACS, from Indiana University in Indianapolis. “Recent ACS research, including the Journal of the American College of Surgeons article by Dr. Childers and colleagues, validates what many of us have long felt: caring for surgical patients is more complex than ever, yet outcomes remain strong.”

Covering Every Front

With panelists Jessica R. Burgess, MD, FACS, from Old Dominion University in Norfolk, Virginia, Jason P. Wilson, MD, MBA, CPE, FACS, from Sentara Health in Hampton, Virginia, and Elizabeth Young from Congressman Ron Estes’s (R-KS) office, Margaret Tracci, MD, JD, FACS, ACS Medical Director of Surgeon Engagement, broadened the lens in the third panel of the morning, "Today's Fight for Surgeons and Surgery: Covering Every Front."

Dr. Tracci emphasized the ACS’s responsibility to serve as a “convener” for The House of Surgery®, reminding attendees that the ultimate goal is to “take care of our patients by taking care of surgeons.”

From that broad vision, Dr. Wilson offered a personal roadmap for engagement. Describing his evolution from disengaged medical student to seasoned advocate, he demonstrated how small steps—sending a message via SurgeonsVoice, serving on committees, developing district relationships—can grow into important influence. His challenge to the audience was direct: “If I’m not doing it, who is going to do it?”

Dr. Burgess expanded on the theme of individual agency, sharing how state-level advocacy can deliver tangible results. Through coalition-building and persistent engagement, she helped advance legislation on hospital safety and non-competes. “You are the advocacy person, just by being here,” she said.

The presence of a congressional staffer in the room was, as it always is at this meeting, instructive. The reminder that most legislators rely heavily on their staff for policy guidance—and that relationships with those staffers are as vital as relationships with the members themselves—is something that bears repeating. Young reinforced that physician outreach matters. When surgeons speak up, “it absolutely 100% gets back to the member,” she said.

Key takeaways from this session included:

• Advocacy begins with showing up.
• Engagement is a ladder—start simple and build upward.
• Relationships drive policy.
• State advocacy is powerful and fast-moving.
• Persistence matters—even in difficult climates.

“If you’ve ever considered engaging in this work, now is the time. I strongly encourage colleagues to attend this summit—it's an unmatched opportunity to strengthen the future of our profession, amplify the voice of surgery, and ensure that data-driven advocacy shapes the policies that impact our patients and our daily practice,” said Dr. Selzer.

Learning to Speak the Language

In the afternoon, the program shifted from issue education to skills development. Knowing how to communicate the substance of healthcare policy, in the compressed and often unpredictable format of a Capitol Hill meeting, is a separate skill set that this summit takes seriously.

The "Advocacy 101" panel, featuring Ross F. Goldberg, MD, FACS, from Jackson Health System in Miami, Florida, and Elise Fannon, MD, MPP, from the University of Pennsylvania in Philadelphia, walked attendees through the mechanics and mindset of an effective Hill meeting (which typically lasts no more than 20 minutes).

The consistent message was to lead with patients, not policy. Legislators hear policy arguments all day. They remember stories.

Surgeons were encouraged to focus on what they are asking for, why it matters, and how policies affect patients. With that emphasis in mind, Drs. Goldberg and Fannon outlined a practical framework for preparation—mastering the content, coordinating strategy with teammates, and executing concise, patient-centered conversations. Even in challenging meetings, advocates should remain positive and bipartisan. Ultimately, the session reinforced that effective engagement is a long-term, relationship-building effort grounded in professionalism, purpose, and persistence.

“I’m not expecting to change anyone’s mind in a 10-minute meeting. It’s a marathon, not a sprint. We have to be persistent," said Dr. Goldberg.

That long-view approach to advocacy is not just strategic, it is transformative. For Dr. Fannon, sustained engagement through the Advocacy Summit has shaped her professional journey in lasting ways: “The ACS Leadership & Advocacy Summit has been formative for me. I’ve always had a sense that I wanted my career to extend beyond the operating room and toward broader impact, but it was at this meeting 5 years ago that that vision really crystallized. Each time I return, it grounds me in my purpose, reconnects me with the joy that brought me to surgery, and energizes me through new ideas, projects, and colleagues committed to walking a similar path. It’s also a place where surgeons are given a real platform to turn that sense of purpose into meaningful advocacy for our patients and our profession. It’s been a beautiful journey from the first time I attended, looking to those around me for examples, to this year, when it felt like others were looking to me. I’m honored to be in that space and look forward to continuing to grow both as a mentee and a mentor along the way.”

Congressional Asks

The ACS Issue and Lobby Day Briefing that followed helped reinforce the plan of action and agenda for the next day. Attendees learned the specific asks they would be bringing to their Congressional meetings, talking points behind each, and the political context that would shape how different offices were likely to receive them.

The asks this year were pointed: Stabilize the Medicare Physician payment system, improve access to breast cancer screening, support surgical research, and support the surgical workforce and patient access to care.

Attendees also participated in interactive advocacy training designed to equip them with the knowledge, practical skills, and confidence needed to engage effectively during Hill Day meetings. Through hands-on exercises and guided discussion, participants refined their messaging and learned how to tailor their approach to different legislative audiences.

Congressman Herb Conaway Jr., MD (D-NJ), joined the summit, reflecting on the importance of surgeon engagement in the legislative process and the impact their expertise can have on national health policy.

On Hill Day, 262 Advocacy Summit attendees representing 39 states participated in 247 meetings.

What happens after Hill Day is harder to measure than the number of meetings held or states represented. Legislative change is slow, nonlinear, and rarely traceable to a single visit. But as the day’s presenters emphasized, the cumulative impact of surgeons showing up year after year in Congressional offices—across party lines—with clear asks, credible expertise, and powerful patient stories—is real.

“The ACS Advocacy Summit is the best organized and most impactful summit focused on surgical advocacy that I have attended. Anyone interested in influencing the future of healthcare in America should consider attending this meeting next year,” said Dr. Gosain.

The 2027 Leadership & Advocacy Summit will be April 10–13 in Washington, DC.

Advocacy and Health Policy Abstract Competition

Ten authors were invited to present their abstracts, and the top three were recognized:

First place: Patrick L. Johnson, MD, MPH—Downstream Medical Costs of Repealing Universal Motorcycle Helmet Laws

Second place: Sheharzad Mahmood, MD, MSc(c)—Reinforcing the Pipeline: A Novel Partnership Between a National Surgical Society and Grassroots Advocacy Initiative to Inspire the Next Generation of Surgeons

Third place: Katayoun S. Madani—Toward Equitable Academic Exchanges: Reforming Texas Medical Licensing to Enable Bidirectional Training in Global Surgery

Jennifer Bagley is the Editor-in-Chief of the Bulletin and Senior Manager in the ACS Division of Integrated Communications in Chicago, IL.