American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

The Communication Pulse: Leadership and Member Perspectives

100 Words

The recent motor vehicle accident that injured Tiger Woods made me think of the progress that has been made in the care of trauma patients. In 1958, a group of Swiss general and orthopaedic surgeons established the AO (Arbeitsgemeinschaft für Osteosynthesefragen) or the Association for the Study of Internal Fixation (ASIF) to transform the contemporary treatment of fractures in Switzerland. This multidisciplinary approach has led to life- and limb-saving strategies that have benefitted countless patients. Mr. Woods’ fractures were stabilized by implants that are considered the standard of care today; the concept was popularized by Gerhard Küntscher.

L. Scott Levin, MD, FACS, Chair, American College of Surgeons Board of Regents

Surgeon Voices

From the Frontlines

In this issue, Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Vice-Chair, ACS Board of Regents, and Director, Digestive Disease Institute at Cleveland Clinic Florida in Weston, FL, interviews:

L. Scott Levin, MD, FACS, Chair, American College of Surgeons Board of Regents, and Eduardo Rodriguez, MD, DDS, FACS, Chair, Hansjörg Wyss Department of Plastic Surgery, Helen L. Kimmel Professor of Reconstructive Plastic Surgery, on Dr. Rodriguez’s role in leading the world’s first successful face and bilateral hand transplant.

Julia Coleman, MD, MPH, RAS-ACS Executive Committee Secretary and RAS-ACS Liaison to the Committee on Trauma, and James C. Jeng, MD, FACS, general, trauma, burns, and surgical critical care surgeon, Crozer Regional Trauma Center, Upland, PA; members of the COT Advocacy Pillar Engagement Workgroup; and co-authors of the March Bulletin article on the importance of early engagement in advocacy, getting to know your legislators, and more.

Practice Protection Committee

Patrick V. Bailey, MD, FACS, ACS Medical Director of Advocacy, Washington, DC, interviews Mark Aeder, MD, MS, FACS, on key legal and financial documents that surgeons should have prepared for their families in the event that they become disabled or incapacitated and need to share the information.

The ACS, Racism and Surgery: Evaluating Our Past to Ensure a Better Future

By John H. Stewart, IV, MD, MBA, FACS, Chair, ACS Advisory Council for General Surgery, and Chair, Council of ACS Advisory Chairs

The role of race in America is complicated. The American College of Surgeons’ Board of Regents, as a leader in surgery in the U.S., recognizes its responsibility to address the issue of structural racism within the ACS and within the profession of surgery. The Board of Regents’ position in the College’s history provides context for our current efforts to address racism in surgery.

The recently convened Task Force on Racial Issues, led by ACS President J. Wayne Meredith, MD, FACS, MCCM, proposed clarifying the history of the African-American experience to foster empathy, justice and inclusion and is a critical step in creating a just and inclusive environment. In November 2020, the task force issued a report of recommendations to act upon urgently.

Herein's work highlights how the College grappled with race at a crucial juncture in its history and how the organization has moved toward more inclusive leadership.

Daniel Hale Williams, MD, FACS, an African-American surgeon from Chicago, IL, was a member of the founding group of the College. Although Dr. Williams was very accomplished, William Haggard, MD, FACS, of Nashville, TN, objected to his application based upon his belief that “…the presence of a ‘negro' would pose an intolerable social problem for the wives of southern surgeons; result in an ‘enormous number of negroes’ applying; and cause southern surgeons to reject the College.” AJ Oschner, JMT Finney, and George Brewer (all MD, FACS) countered that the College is a scientific organization in which an applicant’s race should not overshadow their clinical and research accomplishments. Dr. Haggard acquiesced, and Dr. Williams was inducted into the College in 1913. No other African-American candidates were admitted to the College until Louis T. Wright, MD, FACS, of New York gained fellowship in 1934.

The College failed to address whether deserving African Americans should be accepted for fellowship until October 1940, when seven applicants were recommended for fellowship by their respective credentials committees. Charles Drew, MD, FACS, chair of surgery at Howard University, Washington, DC, and the director of the first American Red Cross blood bank, was among the surgeons whose applications were deferred for consideration in 1940. During the considerable debate about these applications, Evarts Graham, MD, FACS, noted, "These men were coming from excellent medical schools, receiving four years or more of extensive training, and the College simply cannot refuse them admission because they are Black."

Many Regents from the south suggested that given contemporary cultural norms, Black surgeons' inclusion would lead to widespread resignations. This point of view was so prevalent that Board Chairman Irvin Abell, MD, FACS, cited a unanimously carried 1939 resolution that stated, "no applicant shall be granted fellowship in the ACS, whose admission would be injurious to the good order, peace, or interest of the College, or derogatory to its dignity, or inconsistent with its purposes." This resolution was specifically intended to support the conclusion that Black surgeons should not be admitted to the College. Dr. Abell subsequently issued the following statement in addressing African-American applicants “…for the present, the Board of Regents has decided not to admit anymore Negros Fellows.”

Dr. Wright eventually convinced Henry Cave, MD, FACS, a Regent and future President, to form the Committee on the Relation of the Colored Surgeon to the American College of Surgeons in 1945. This committee interviewed Black surgeons and issued questionnaires to more than 200 fellows. The committee’s findings did not support the fear of mass resignations from the south, and four members were approved for fellowship in 1945. More than 60 fellows were inducted into the College between 1945 and 1950, including Helen Octavia Dickens, MD, FACS, an obstetrician-gynecologist from Philadelphia, the first African-American woman to gain fellowship in 1950.

Unfortunately, Dr. Drew did not obtain fellowship in the College before his untimely death in a tragic automobile accident on April 1, 1950; however, he was ultimately granted posthumous fellowship in 1952. Dr. Drew’s legacy lives on in the past and current leadership of the College. LaSalle D. Leffall, MD, FACS, one of Dr. Drew’s students, was elected secretary of the College in 1983 and President in 1995. Edward E. Cornwell, III, MD, FACS, FCCM, FWACS(Hon), one of Dr. Leffall’s students and the LaSalle D. Leffall Endowed Chair of Surgery, Howard University College of Medicine, was elected secretary of the College in 2013; and Patricia L. Turner, MD, MBA, FACS, Director of ACS Member Services, served as a resident under Dr. Leffall at Howard University College of Medicine.

The College’s journey toward more inclusive leadership also includes the elections of Claude Organ Jr., MD, FACS, and L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), to President in 2003 and 2010 and the election of Lisa Newman, MD, MPH, FACS, FASCO, as Second Vice-President-elect in 2019.

Achieving the lofty goals of our motto “to serve all with skill and fidelity” will require ongoing evaluation of our organization’s diversity and inclusion efforts. Strategic actions around these efforts must be informed by our history so that we do not repeat past mistakes.

Charles Drew
Claude Organ Jr.
Edward E. Cornwell, III
LaSalle D. Leffall
L.D. Britt
Patricia L. Turner