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

The Communication Pulse: Leadership and Member Perspectives

American College of Surgeons Call to Action on Racism as a Public Health Crisis: An Ethical Imperative

—From the American College of Surgeons Board of Regents and American College of Surgeons Committee on Ethics

As the novel coronavirus (COVID-19) pandemic upends our world and continues to take its extraordinary toll on human life, our nation experiences the horror of yet another senseless killing of a Black person by the police. At the same time as we are witnessing the disproportionate ravages caused by COVID-19, especially in African-American and other disenfranchised communities, we continue to experience the compounding effects of systemic racism that prompted the recent killing of Ahmaud Arbery, Breonna Taylor, and now George Floyd.

At a time when people are desperately seeking a vaccine to allow them to shed their “protective face masks” and return to a semblance of normalcy, unfortunately, African Americans continue to confront, all too frequently, mistreatment or brutality by some law enforcement officers, which has given rise to more than an aspirational slogan, but rather an urgent cry: “Black Lives Matter.” Mr. Floyd’s death in Minneapolis, MN, has brought outraged protesters from diverse backgrounds to the streets of many cities and has resulted in a national and international outcry for justice, an end to police violence against Black men and women, and a long overdue correction of this country’s deep racial inequalities.

These unprecedented crises call for enlightened and innovative leadership, inspired intervention, and compassionate service from all members of the American College of Surgeons (ACS).

We must work arduously to accelerate the elimination of the unacceptable inequities that pervade our health care system and our world at large. As the COVID-19 pandemic has painfully illustrated, these inequities, fostered by our society’s racism, keep African Americans and other racial and ethnic minorities (Indigenous, Latinx) from receiving the accessible, high-quality care that every American deserves. Structural racism, manifested by deep inequities in housing, employment income, and education, contributes to a greater prevalence of underlying chronic conditions.

Moreover, as noted by the Institute of Medicine (now the National Academy of Medicine), even after adjusting for education and economic status, unequal treatment resulting from racial discrimination exacerbates health disparities. The result is a higher death rate from coronavirus infection and many other conditions. Police brutality against people of color further endangers the well-being, health, and lives of a great number of our patients. Correcting these injustices now, by denouncing racism and its deleterious effects on the health of Black and Brown people, is among the most important missions of the ACS.

As an organization that strives to inspire quality and create the highest standards and outcomes for the surgical community, the ACS is committed to creating a more just and inclusive environment for everyone. Therefore, we will continue to work to ensure the development of a culturally competent and diverse surgical workforce to meet the health needs of our nation. We will continue to pursue our research and public health initiatives addressing health disparities. In addition, we will accelerate our advocacy efforts to bring much-needed legislative reform to correct factors that negatively affect the health of our patients and communities in order to ensure better outcomes for all human beings, regardless of ethnicity, race, gender, creed, religion, nationality, or sexual preference.

100 Words

The responsibility of any professional organization is to meet the needs of its members. The purpose of the American College of Surgeons (ACS) is to serve the health care needs of patients by setting the highest standards in order to maintain surgical excellence. The ACS has admirably represented the House of Surgery throughout the COVID-19 pandemic, with its finger on the pulse of our members. The profound adverse financial impact of the crisis has not gone unnoticed. By recognizing that the road to recovery will be challenging, the ACS leadership has decided to not increase dues payments this year. We trust that this decision will be meaningful to all.

— Beth H. Sutton, MD, FACS, Chair, American College of Surgeons Board of Regents

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

Surgeon Voices

In this issue, American College of Surgeons (ACS) Regent Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Director, Digestive Disease Center at Cleveland Clinic Florida in Weston, FL, interviews:

Gary L. Timmerman, MD, FACS, attending surgeon, Sanford Surgical Associates; professor and chair, department of surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD; and ACS Regent, who discusses his hospital’s and South Dakota’s response to COVID-19, particularly in light of the large spike in case numbers that occurred in the meatpacking worker population in April. Though South Dakota did not declare a formal stay-at-home order, public information campaigns, local isolation centers, and other initiatives helped to keep the number of case infections low, even with the unexpected initial surge. In addition, Dr. Timmerman discusses the state of surgery and his practice in South Dakota, as well as the realities of geographic disparities in access to care in the state.



Badma Bashankaev, MD, FACS, FASCRS, Health Advisor to the Head of the Republic of Kalmykia, Russia, and chief of surgery, Global Medical System Clinics and Hospitals, who discusses how COVID-19 is affecting Russia, where new case diagnoses appear to have started leveling out after a sharp increase in May. Focusing primarily on Moscow, Dr. Bashankaev speaks about how hospitals prepared for the delayed patient surge, the state of Russia’s “stay-at-home” order, the role of social media in informing patients and surgeons about COVID developments across the world’s largest country, the availability of testing, and more.



Your Leaders at Work

Highlights of the June Board of Regents Meeting

Over the course of the last week, the Board of Regents of the American College of Surgeons (ACS) met virtually, and all of the Regental Committees met by remote video conference.

Reports on budget planning for the 2020−2021 year and investment strategy during the economic downturn were reviewed. Overall, the College has been able to reduce expenses to adjust for COVID-19’s effects on reduced revenue. The budget for 2020−2021 will be carefully monitored and additional adjustments will be made as needed. The Board voted to have no dues increase in 2020–2021.

The Division of Advocacy and Health Policy continues to work on regulatory changes affecting Medicare pay-for-performance programs and to reduce regulatory burdens. A public campaign will be undertaken in the next several months through the Surgical Care Coalition in partnership with the Brunswick consulting firm. The goal will be to prevent the Medicare cuts proposed for 2021.

The Division of Education and the ACS Academy of Master Surgeon Educators is developing resources to support medical students who are considering a surgical career. The Division has provided resources to students, residents, and fellows during the pandemic. An initiative to use video and remote learning is in development and will be overseen by a new committee.

Planning for Clinical Congress 2020 to be presented remotely and consideration of a smaller live meeting in Chicago, IL, is under way. Issues to be addressed, based on the results of a member survey, include surgeons’ willingness to attend, the ability to realistically maintain social distancing with large crowds, and the impact of travel restraints some institutions have imposed. The concerns about a second surge in COVID-19 cases and the subsequent effect on the surgical workforce are real and are under consideration. A final decision will be made over the next two weeks.

The Division of Research and Optimal Patient Care is developing the ability to support existing and new verification programs through a virtual verification review process. The College registries have added data collection opportunities for COVID-19-related information. The ability to bundle participation in multiple programs is being planned to increase efficiency and lower costs for hospitals that participate in ACS Quality Programs.

The Division of Member Services heard proposals from the Board of Governors, Young Fellows Association, and Resident and Associate Society aimed at increasing member engagement, embracing educational opportunities, expanding leadership development, and increasing participation among women and ethnic and racial minorities in the College. We also discussed engaging rural surgeons, international surgeons, and surgeons of all specialties.

The Division of Integrated Communications development of the Bulletin Brief newsletter was championed. Plans to transition this success to include College issues of broad interest to the Fellows are under way. A strategic redesign of digital communications (facs.org and social media) also is in progress and will be a priority over the coming year.

Concern about the recent public outcry over racism and violence was discussed. A group will form to explore specific ways the College can address this issue as a professional organization and hold ourselves accountable.

The Regents spent a half-day considering the future of the College and important issues that will need strategic planning. Overall, the Board meeting was a success, and though the loss of social interaction was evident, the remote meeting was well attended, well led, and the work necessary to go forward was accomplished.

Member Services Liaison Committee Updates

The American College of Surgeons (ACS) Member Services Liaison Committee (MSLC) met June 4 to receive annual reports from the Chairs of the Resident and Associate Society (RAS-ACS) and Young Fellows Association (YFA) and the Medical Director of Operation Giving Back (OGB). Each group provided a detailed overview of its accomplishments and goals, as well as any perceived obstacles. Time was allocated between reports for committee members to ask additional questions and offer recommendations to help effect change.

Highlights of the meeting were as follows:

The RAS was able to switch gears quickly and respond to the challenges posed by COVID-19. Not only were the workgroups able to maintain normal workflow, but they also were able to provide additional programming. A well-received, 15-week series of one-hour educational programming was developed for residents and medical students to help fill the gap in educational opportunities. Furthermore, a COVID-19 Task Force was formed, which created a survey to assess the effect of the pandemic on the residents’ clinical, educational, and personal experience. The survey is expected to be disseminated shortly, and results will be provided to the Board of Regents later this summer. 

The YFA had an equally successful year. The YFA is particularly committed to the goals of heightening participation among women and minorities, improving the reach of the mentoring program, and increasing collaboration with other committees. Reported challenges, primarily resulting from changes implemented because of COVID-19, included: decreased opportunities for in-person meetings, fewer funding opportunities for Continuing Medical Education activities, and an overall change in the dynamic of academic medicine. Possible solutions include partnering with other ACS committees and associations, using online platforms for meetings and lectures, and increasing outreach through social media channels.

OGB continues to do well. Its strategic partnerships are strong and engaged. The first Advanced Trauma Life Support® course for sub-Saharan Africa, set to launch at the Hawassa Hub, Ethiopia, in March, was sidelined because of the pandemic. The course subsequently has been converted to a virtual format and will launch this week. Eight additional surgery departments would like to participate in a second hub. Decisions regarding whether to take the program to the next level and how to fund it will be made in the future.

The MSLC sought feedback for converting or developing an array of educational content into short video clips, and the RAS and the YFA expressed a willingness to help pilot the project. The MSLC also discussed streamlining the application process for residents and creating a domestic training hub, like Hawassa.

Division of Research and Optimal Patient Care Committee Meeting Centers on Adapting to Changing Environment

The Division of Research and Optimal Patient Care Committee (DROPCC) met virtually June 5 in conjunction with the Board of Regents. The DROPCC focuses on overarching issues and provides specific, meaningful, and achievable recommendations for enhancing the American College of Surgeons (ACS) Quality Programs.

A key topic at the meeting was the work of the Task Force on the Future of the ACS Quality Programs. The Task Force, along with the committee, has been working to determine how to highlight the value of our programs, relieve the burden on the hospitals, make the programs more accessible, and increase the return on investment.

The committee provided insights into what has occurred during the COVID-19 pandemic. As a result of the pandemic, the ACS has modified operations to adapt to the needs of the changing health care environment. A main component of the ACS Quality Programs is Accreditation and Verification site visits. ACS leadership and staff are in the process of determining whether it’s necessary to have in-person or virtual site visits, or a hybrid of both.

The areas of Cancer and Trauma provided updates on the programs in their respective areas. Trauma Programs shared their approach to shifting to a virtual reverification visit, as well as the work they are doing with the New York City Committee on Trauma in response to the COVID-19 pandemic. Cancer Programs presented their proactive response to COVID-19 and their work to develop simplified tools for their reports. The Division of Advocacy and Health Policy shared its recent work with regulatory agencies as these efforts relate to ACS Quality Programs.

Lastly, the DROPCC discussed the shift of the ACS Quality and Safety Conference from an in-person meeting to a virtual event. The virtual format will provide the opportunity to expand the conference to a larger audience, including international surgeons and registrars, C-suite executives, and other health care professionals. The committee was enthusiastic about hosting and participating in the virtual conference.