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

Summer 2012

Editor’s Comments

Message from the YFA Chair

Leadership Advice

Clinical Congress Update

Advocacy and Health Policy

Who We Are

Surgeons in Their Spare Time

Editor Comments

Dear YFA members,

Welcome to the Young Fellows Association (YFA) e-newsletter of the American College of Surgeons (ACS)! We are developing a format that will interest you and is responsive to your needs and concerns. Along those lines, we will run some recurring items each quarter:

  • Editor Comments/YFA Newsletter Poll—A word from the editor along with a new YFA Newsletter poll, including results and commentary from the previous poll.
  • YFA Chair’s Message—A word from our YFA Chair.
  • Leadership Advice—A letter from a surgical leader and visionary outlining what we need to develop in ourselves as future leaders.
  • Clinical Congress Update—ACS meeting update and advice on the sessions that Young Fellows really need to attend.
  • Advocacy and Health Policy—An update from the Hill: How will health policy changes affect those of us who will practice long enough to really see the changes?
  • Surgeons in Their Spare Time—Keen insight on what we should be doing or are doing in our spare time.

We are very interested in what you have to say and what you are interested in reading about in the newsletter. Two new sections in the YFA Newsletter will promote these two aims.

The first new section is A Piece of My Mind. Each quarter, the newsletter will feature an essay written by one of you—our members. It can be about anything that is on your mind: your practice, health policy, work/life balance. Please send your comments to me at ellen@qualityhealth.org to have your piece featured in a future YFA Newsletter.

The second new section called YFA Membership Poll makes its debut in this edition of the YFA Newsletter. We will pose a question in each issue and ask you to respond by clicking on the included link. We will report back to you the results of the poll in the next YFA Newsletter.


YFA Membership Poll

In the Spring 2012 issue we asked readers to indicate their preference for receiving ACS materials. The results of the polls were

35, e-mail
3, printed material
2, text message
4, Facebook
1, Twitter

So it looks like we will continue sending our communications via e-mail. Thank you for taking the time to submit your response!

The summer question is:

How long do you see yourself practicing surgery?

  • Until you retire from professional work
  • Until you have enough money to stop and then do what you really love
  • You cannot imagine the day

To respond please click THIS link.

As always, thank you for your time, and I look forward to our exchanges,

Ellen Farrokhi, MD, FACS
Editor, YFA Newsletter
Vascular Surgery
Providence Regional Medical Center
Everett, WA


Message from the YFA Chair

As the Chair of the YFA, one of the most common questions I receive is, “What is a Young Fellow?” If you are a Fellow of the College and are 45 years of age or younger, that’s you! and we invite you to become involved in the College and the YFA, whether it is in your hometown, state, or at a national level.

I would like to encourage you to read our recently reformatted YFA newsletter, browse the ACS website, and learn more about the many exciting areas in which the YFA Governing Council is involved. We represent the broad face of surgery with members from such specialties as urology, surgical oncology, general surgery, orthopaedics, and vascular surgery. We are academic, private practice, and employed surgeons living in different U.S. regions as well as internationally. As you read our newsletter you will see that our interests are broad, ranging from advocacy efforts, surgical education, and mentorship programs to other issues that we face, including work/life balance.

We are extremely proud of the increased growth and visibility of the YFA over the last two years. We are fortunate to have an open roundtable discussion with the newly elected ACS President immediately following our annual open meeting at Clinical Congress. This year Brent Eastman, MD, FACS, who will take the reins of leadership at the Clinical Congress, has graciously made time for us on Monday afternoon, October 1, and we encourage all of you to attend and meet him and ask questions. This will be followed by an open reception to give you the opportunity to meet the YFA Governing Council and discuss the issues that are most important to you and your surgical practice and learn how you can become an active member of the YFA.

If you are interested in becoming involved in the ACS, you can find no better place than the YFA! Please do not hesitate to contact me if you have any questions or comments. Thank you for reading the YFA Newsletter!

Sincerely,

 Laurel C. Soot, MD, FACS

Laurel C. Soot, MD, FACS
Chair, Governing Council
Associate Clinical Professor of Surgery
Oregon Health and Sciences University
Portland, OR
The Oregon Clinic: Westside Surgical Specialists
Tualatin, OR


Leadership Advice

From Julie Freischlag, MD, FACS, and David B. Hoyt, MD, FACS

Future Leaders: What Does It Take?

Leadership is like an art form, in that there is no prescription or outline that will prepare you for all of the situations you will encounter. Some people seem to be “natural” leaders—they always seem to be in the right place at the right time and know exactly what to say and do. Others tend to struggle a bit but grow into their position over time by paying attention and soliciting feedback along the way. I would argue that most admired leaders do a bit of both—they have a natural style and also work on complex problems behind the scenes while asking for input from others. Over my 10 years as chair of the department of surgery at Johns Hopkins Medical Institutions in Baltimore, MD, I have benefitted from continuous feedback. I consider myself a more effective leader now than when I started back in 2003, and hope that I will continue to grow as a leader.

So what does it take—and what will it take—to be a successful leader in surgery? I think the top three factors for becoming a leader will never change.

1. Be a very good physician, surgeon, researcher, and/ or teacher. In order to lead, you need to demonstrate that you are very good at what you were trained to do as a surgeon or scientist and establish that you can work with others and be part of a team as you go up through the ranks.

2. Have passion for others’ successes and development. It is no longer about you when you become a leader. It is about the people you lead. You have to be at a stage in your career when having others obtain success (for example, doing a tough case, presenting a paper, getting a grant or award) is more important and enjoyable than having done so yourself.

3. Possess a high degree of emotional intelligence.1 Emotional intelligence allows leaders to grow and be successful over long periods of time. Emotional intelligence includes self-awareness, self-regulation, motivation, empathy, and social skills. Understand your emotions and the effect they have on others. You need to be able to control your emotions, think before acting, and redirect your disruptive moods, demonstrating passion for your work that goes beyond money or status. You also should try to understand the emotional makeup of others and treat them accordingly as individuals. You must proficiently manage relationships, find common ground, and build rapport.

There is nothing more rewarding for me than to be a leader and to watch all of those in my department grow and accomplish amazing things. As the residents leave my office every Monday morning after I meet with them, I say—“Go forth and do great things!” And they always do.

“If every day is an awakening, you will never grow old. You will just keep growing.” –Gail Sheehy

1. Goleman, D. What makes a leader? Harv Bus Rev. 1998;Nov-Dec;76(6):93-102.

Julie Ann Freischlag, MD, FACS
The William Stewart Halsted Professor
Chair, Department of Surgery
Johns Hopkins Medical Institutions
Baltimore, MD

Comments on Leadership

The opportunities for leadership today in surgery are plentiful. As we have a public debate about health care entitlements, the need to improve care, and the maintenance of quality and value, there is much confusion and anxiety. Surgical leaders have put forth the principles by which we have practiced for 100 years. Setting standards and committing to systems of excellence, the measurement of performance, and external peer review are the principles by which we have led ourselves and defined our professional commitment.

Leaders tend to foresee events and consider solutions sooner than their peers. Leaders are thereby able to help formulate solutions to complex problems, unify those around them, and work for the common good. Leadership in this case is not about one’s self, but about how to bring others along. In continuing your commitment to your patients and the excellence with which you practice surgery every day, consider the opportunity to participate in a leadership role on behalf of the profession.

The rewards can add to your personal satisfaction in knowing you are part of something that will benefit you and your patients. I encourage everyone to take advantage of leadership opportunities. These opportunities extend from leading the team of practitioners in your hospital during direct patient care to participating in the national activities of the ACS. 

Surgeons are, by definition, leaders. I tip my hat to all of you who have taken advantage of this wonderful opportunity to serve your patients and your colleagues.

David B. Hoyt, MD, FACS
Executive Director, American College of Surgeons


Clinical Congress Update

The upcoming Clinical Congress, which will kick off a year-long celebration of the ACS Centennial, promises to be an exciting meeting with a robust series of panel sessions and an inspiring scientific program. The YFA proudly sponsors two outstanding sessions that we think would be of great interest to our members. Please consider attending the following YFA-sponsored sessions:

Monday, 2:30–4 pm
PS117: The Surgical Lifestyle: Finding Joy in the Profession

Moderated by Danielle Katz, MD, FACS, and Joshua Broghammer, MD, FACS, this session will focus on strategies and techniques for young surgeons to combat work-related burnout, maintain staying power in the surgical profession, and find joy in their surgical practice.

Tuesday, 12:45–2:15 pm
PS217 The Joys and Trials of Being an Employed Surgeon: Is It Right For You?

Moderated by Keith Amos, MD, FACS, and Scott Coates, MD, FACS, this session will outline the factors that cause surgeons to become employed surgeons, as well as the benefits and pitfalls of being an employed surgeon.

Other sessions of interest

Monday, October 1
9:45–11:15 am, PS103: Employing an Allied Health Professional: The Practical Realities
9:45–11:15 am, PS105: Parenting Beyond Pregnancy: The Challenges of Becoming a Surgeon-Parent 
11:30 am–1:00 pm, PS 114: Why Surgeons Need to Understand Social Networking 
4:15–5:45 pm, PS 123: Founders of Private Clinics and the Early History of the ACS 

Tuesday, October 2
8:00–9:30 am, PS200: 10,000 Hours vs. 10,000 Cases: How to Train the Modern Day Surgeon 
8:00–11:15 am, PS207: Spectacular Cases from Residents 

Wednesday, October 3
8:00–11:15 am, PS306: Surgical Jeopardy
12:45–2:15 pm, PS311: Career Advancement for the New Academic Surgeon

Jacob Moalem, MD, FACS
Liaison, American Medical Association—Young Physicians Section
Assistant Professor
University of Rochester


Advocacy and Health Policy

From John E. Hedstrom, JD

Earlier this summer, the U.S. Supreme Court upheld the Affordable Care Act (ACA), health reform legislation passed in 2010, and gave interested stakeholders a clear understanding of the new baseline for health care policy. In the coming months there will be more talk about repealing the law following the November elections, but a repeal remains highly unlikely even if the Republicans gain control of the White House and U.S. Senate. The Republicans will not win enough seats in the Senate to avoid a filibuster of any attempt to repeal the ACA. For young surgeons, the law’s impact is divided into two distinct parts. The first centers on specific provisions in the law—such as the creation of an Independent Payment Advisory Board—and certain issues that were not specifically addressed, including Medicare physician payment (sustainable growth rate), the surgical workforce, and medical liability reform. The ACS will have to tackle each of these issues individually in the months and years ahead. The second part centers on the reality that the ACA focuses more on coverage issues than reformation of the health care delivery and payment systems.

With or without the ACA, all physicians, including young surgeons, will see substantial change in the future health care delivery and payment system. The sheer cost of our health care system has already caused corporations and insurance companies to explore alternative physician payment methods. On Capitol Hill, there is growing bipartisan consensus that Medicare and Medicaid must adopt similar changes as the nation grapples with long-term fiscal issues. Once you get beyond the rancor as to how Americans should be covered, you will see many similarities in the competing proposals to change the Medicare program—moving away from paying for volume (fee-for-service medicine) and toward paying for quality and value. The ACS is committed to responding to the changing needs of the health care system with the firm belief that any change must be patient-centric and physician-driven. For more information related to how ACS is confronting the challenges ahead, e-mail ahp@facs.org and one of the health policy and advocacy staff in our Washington Office will get back to you.

John E. Hedstrom, JD
Deputy Director, Division of Advocacy and Health Policy
American College of Surgeons


Who We Are

The Governing Council of the YFA consists of 15 national and international Fellows of the College age 45 and younger. Membership is based on representation needs, specialty, geographic location, and input from the Board of Regents, Advisory Councils, chapters, current YFA members, and the societies that represent underrepresented groups. Our mission is to represent the interests and concerns of Young Fellows and to promote their active participation and input to support ACS activities. The Board of Regents must approve all nominations for members of the Governing Council. For more information, visit the YFA website.

The YFA recently nominated four new members to its Governing Council. They are:

  • Rebecca Britt, MD, FACS, Acute Care Surgery, Norfolk, VA
  • David Cooke, MD, FACS, Cardiothoracic Surgery, Sacramento, CA
  • Joe Dubose, MD, FACS, Acute Care Surgery, Baltimore, MD
  • Daniel Klaristenfeld, MD, FACS, Colorectal Surgery, San Diego, CA

S. Rob Todd, MD, FACS
YFA Nominating Committee Chair
Assistant Professor
Weill Cornell Medical College
New York City, NY


Surgeons in Their Spare Time

The most serious threat to every young surgeon’s personal and professional life… inoculate yourself.

I am talking about a condition, a threat that has repeatedly targeted surgeons, specifically young surgeons. It is linked to an alarming increase in medical errors, emotional exhaustion, physical illness, poor job performance, substance abuse, and dysfunction in one’s personal life.1-4 Although this condition is often blamed on the nature of our profession, it is perhaps better attributed to our generation’s social expectations, and the ways we expect and choose to balance career, family, and personal growth and meaning.3,5 Young surgeons remain at high risk, and within their first professional decade one out of every three will fall victim to this threat. If left untreated, this condition will, ironically, lead to an impairment of the very thing we attempt to preserve: our professional life and our patient-surgeon relationship. This threat is professional burnout. 

Professional burnout—a preventable condition—remains on the rise among young surgeons, but not due to a lack of understanding of its pathophysiology or a lack of a preventive strategy. Instead it is due to a lack of awareness and understanding among its victims. Many of us are unaware of its existence, while others believe that it is part-and-parcel to our profession (a viewpoint shown to be untrue), and others are simply too busy to care. We need to break this trend, educate ourselves, and prevent burnout. We owe this to our families, our patients, our profession, and ourselves. Several authors in the April issue of the Annals of Surgery, delineated a few attainable steps that would improve the surgeon’s quality of life and reduce burnout.6 Ten minutes a day is a good initial step, so let’s get started. 

Top three things you can do now:

  • Exercise.
  • Get enough sleep.
  • Maintain and invest in relationships.

1. Balch, CM Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg. 2011;254(4):558-568.

2. Bertges Yost W, Eshelman A, Raoufi M., A national study of burnout among American transplant surgeons. Transplant Proc. 2005;37(2):1399-1401.

3. Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield. Burnout among American surgeons. Surgery. 2001;130(4): p. 696-702; discussion 702-705.

4. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.

5. Shanafelt T. A career in surgical oncology: finding meaning, balance, and personal satisfaction. Ann Surg Oncol. 2008;15(2):400-406.

6. Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele DV, Hanks JB, Sloan JA, Balch CM. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg. 2012;255(4):625-633.

Adnan Alseidi MD, FACS
Education Work Group
Clinical Assistant Professor
Virginia Mason Medical Center
Seattle, WA