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

Summer 2013

Message from the Editor

Saying Goodbye

It is with great sadness that I begin this edition of the YFA e-News with the news of the passing of our colleague and dear friend, Keith Amos, MD, FACS. Dr. Amos was the National Medical Association liaison to the Young Fellows Association (YFA) Governing Council. He was a surgical oncologist and an assistant professor at the University of North Carolina (UNC) School of Medicine in Chapel Hill. His sudden passing occurred while he was in Edinburgh, Scotland, on the prestigious ACS Claude H. Organ, Jr., MD, FACS, Traveling Fellowship. Dr. Amos was beloved by family, friends, colleagues, and patients and will be sorely missed by all of us in the YFA. Those who wish to leave memories of Dr. Amos may do so at Dr. Keith Amos Remembered.

Two scholarships have been created to honor Dr. Amos. The Dr. Keith Dave Amos Endowed International Fellowship will provide funding for international educational opportunities for medical students attending the UNC School of Medicine. To donate, please send a check to the Dr. Keith Dave Amos Endowed International Fellowship, 880 MLK Jr. Boulevard, Campus Box 7565, Chapel Hill, NC 27514-2600. (Please make checks payable to "The Dr. Keith Dave Amos Endowed International Fellowship").

In addition, the Dr. Keith Dave Amos Endowed Scholarship will provide support for undergraduate premedical students attending Xavier University of Louisiana, New Orleans—Dr. Amos' alma mater. To donate, please visit https://giving.xula.edu/index.html and type "Keith Amos Scholarship" in the Gift Designation/Comments section.

Saying Thanks

The YFA would like to congratulate Peg Haar on her recent retirement. Peg has been a longtime staple with the College, having worked as an Administrator in the Division of Member Services for the past 12 years. She was well known as the College liaison for the Resident Associate Society and, more recently, took on the added role of coordinating the YFA. Peg was responsible for much of the behind-the-scenes organization of YFA events and meetings. We offer her our gratitude and thanks for a job well done and wish her the best of luck in the future.

YFA Membership Poll

In the last issue we asked readers what was the biggest threat to the sustainability of their surgical practice. The results of the poll are in:

  • 48% say disruption of work-life balance
  • 43% say declining reimbursement
  • 14% say increasing overhead
  • 14% say governmental regulation
  • 5% say increased patient volume

This edition's question is: What's your favorite way to spend your free time away from your surgical practice?

  • Traveling
  • Exercise
  • Spending time with family
  • Playing with pets
  • Catching up on much-needed sleep
  • Free time? I've never heard of it

As always, thank you for your time, and I look forward to our exchanges. If you have a column you would like to submit on how surgeons should be spending their spare time or if there is an issue you would like to sound off on, please contact youngfellows@facs.org. Watch for the special Fall edition of YFA e-News with the Clinical Congress Preview.

Joshua A. Broghammer, MD, FACS
YFA e-News Editor
Assistant Professor of Urology
Kansas University Medical Center, Kansas City


Message from the YFA Chair

Summer is always a good time to reflect on where we are, where we have been, and where we are going. This has been another good year for the YFA. We continue to gain momentum and visibility within the College. The recent Leadership Conference in Washington, DC, had state and regional chapter breakout sessions, where many attendees reported that they have specific goals to increase the membership and active involvement of residents and young surgeons within the College. The YFA has the start of an active database of Young Fellows who want to be involved, and we are using it to identify individuals when we get specific requests. Recently, we submitted several names of individuals for the International Relations Committee and are currently compiling a detailed list of surgeons and their subspecialty interests to propose as co-moderators at Clinical Congress. Our mentorship program also continues to grow. Recently, YFA Vice-Chair Rob Todd, MD, FACS, and I held our first international Web-based meeting with the leadership of a group of young surgeons from Australia.

We are looking forward to the ACS 2013 Clinical Congress, October 6–10, in Washington, DC, where we will welcome Fellows and new initiates into the YFA. If you are 45 years old or younger, or are “young at heart,” we invite you to attend our Initiates Program on Leadership Skills on Monday, October 7, 2:30–4:00 pm. Immediately following is our open meeting and active roundtable discussion with the new ACS President, Carlos Pellegrini, MD, FACS. Following the meeting, attend a reception with appetizers, cocktails, and a chance to meet the YFA Governing Council and discover all the opportunities available in the College.

Sessions of Interest

Monday, October 7

  • (ME101) Burning Issues in Surgical Ethics: Collaborations with Industry and Potential Conflicts of Interest
  • (ME108) How to Get Your Research Published
  • (PS114) Initiates Program: Titrating Your Leadership Skills—A Primer for Young Surgeons

Tuesday, October 8

  • (PS223) Implementing Social Media Applications into Your Continuing Professional Development
  • (PS230) Reimbursement in the Age of Accountable Care Organization Bundling: What Are Surgeons Worth?

Wednesday, October 9

  • (PS309) The Modern Family: Surgery 2013
  • (PS316) Nonsurgical Education: Is It Worth Going Back to School?
  • (PS326) Risk and Opportunity of Employed Physicians in an Integrated Health System

Thursday, October 10

  • (PS405) What's New in Advocacy and Health Policy: Top 10 Advances in the Past Year

Don't forget that the Clinical Congress can be a family affair. The College hosts Camp ACS during the week, which will include an exciting on-site children's camp in Washington, DC. With activities such as arts and crafts, games, and movies, your children will not want to leave. You will be able to attend the meeting with the peace of mind that they are being taken care of and having a great time, too!

Hours of operation are Sunday, October, 6, through Wednesday, October 9, from 7:30 am to 10:00 pm at the Renaissance Washington, DC, Downtown Hotel (one block from the Walter E. Washington Convention Center). Registration is open to children 6 months to 17 years of age. Online registration is available.

In the lazy days of summer, I ask you to think about how you would like to be involved in the ACS. If you are interested in active participation or want more information regarding specific opportunities at a local chapter or national level, please e-mail youngfellows@facs.com.

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


Message from the YFA Chair-Elect

Young Fellows and the 2013 ACS Advocacy and Leadership Summit

The 2013 ACS Leadership and Advocacy Summit took place April 13–16 in Washington, DC. The YFA was actively involved in the Leadership portion of the Summit. During a panel presentation titled “Improving Involvement,” YFA leaders discussed how to better engage Young Fellows in the YFA and the ACS and Young Fellows Mentorship Program. Both presentations noted ample opportunities for the involvement of Young Fellows within the ACS.

If you were unable to attend the ACS Advocacy and Leadership Summit this year or are interested in becoming more involved in the YFA, it's never too late. Please contact the YFA at youngfellows@facs.org to learn more.

S. Rob Todd, MD, FACS
Chair-Elect, Governing Council
Associate Professor
NYU Langone Medical Center, New York, NY


Leadership and Advocacy Summit 2013: A Personal Perspective

The last time I was in Washington, DC, I was 17 years old and looking at colleges with my parents. I was never interested in the happenings of our nation’s capital, in much the same “head in the sand” way that many of my patients don’t really want to know what I am going to do with them once they fall asleep in the operating room.

The ACS Leadership and Advocacy Summit was going to change that.

Three hundred surgeons from across the nation met to discuss pressing issues that demand the federal government’s attention. The attendees included a smattering of medical students, residents, rural and urban community surgeons, academic surgeons, surgical subspecialists, and ACS national leadership.

After a full day of discussing issues such as the impending surgeon workforce shortfall, the shortcomings in graduate medical education (GME) spending for residency training, and the need to repeal and replace the Medicare Sustained Growth Rate (SGR), I was prepared for my assault on Capitol Hill. Certainly my government representatives wanted and needed to hear what I had to say.

I had my talking points, a few folders from the organizers, a stack of my business cards, and a neat iPhone app to keep track of my appointments with representatives. My first meeting was with my fellow Californians and a California Representative. After making our way through security and the confusingly narrow halls of the House of Representatives, we found the office. Excited to finally meet a member of Congress and address our delegations concerns, we were shown to a small table in the corner of the front office where we met a very nice 20-something woman who was the Congressman’s aide. Over the next few minutes, she furiously took notes on our issues as we pounded through the acronyms. Once she understood who we were and why we were there, things went a bit smoother. At some point, her eyes glazed over as we pontificated on the importance of GME funding. “We are losing her,” I thought.

Then I asked if she knew anyone in medical school. She had a friend who would be graduating soon. What if that friend couldn’t get a job because there was not enough funding for residencies? The connection was made. She promised to take our concerns to the Congressman as soon as possible as we piled folders of ACS literature and business cards on her desk.

We were a bit disappointed that we would not meet directly with the Congressman, but as we got up to leave, we ran into the Congressman’s wife, who said, “Let’s see if he has a minute to meet with you.” She rushed into her husband’s office with our group in tow. A quick handshake later, we were standing in the Congressman’s office discussing our issues. He was very outspoken in his support for all of the items we wanted to speak about. Then with a rush of motion, he was off to a vote on the House of Representatives floor. Congratulatory smiles and pats on the back later, my group was off to our next meeting.

We rushed across the Capitol lawn to enter the Senate side for a meeting with an aide to a California Senator. I was feeling pretty great after my last meeting. This advocacy thing is a piece of cake. Then we met the Senator's knowledgeable aide, a long-term staffer. She finished sentences for us, spoke of acronyms and organizations we weren't aware of, and gave us talking points to help us with our pitch. She confidently and knowledgeably mentioned important legislation and bills that should concern us. Our delegation left the Senator's office feeling a bit steamrolled.

By late afternoon, I was a bit battered, stunned, hungry, and tired as I headed for the last meeting of the day with another Representative. By now the rest of the California delegation had departed, I had given away all of the ACS literature that I was supposed to present to the Representatives as well as all of my business cards, and my nifty new iPhone app was on the blink. As I shook the Congresswoman's hand, I realized that tactic wasn't going to work. She was polite and considerate, listening carefully as I mumbled through my talking points. Something about GME and SGR and bad things to come if she didn't act quickly. She seemed to take pity on me for not remembering the issues clearly, not recalling what the acronyms meant, and not having literature to give her or my card to present. She said, "It was nice to meet you. My husband is also a physician so I understand. Now, excuse me, I need to go to the House floor to vote," and we parted ways.

From this experience, I learned that advocacy is about connecting with people and establishing relationships. Washington, DC, doesn't work smoothly or quickly, and continuing to develop strong relationships with the people who make it work is the key. Discussions and decisions regarding health care are being made with or without the input of the ACS and surgeons in general—it's better if we came to the table with constructive suggestions as part of the solution. It is incumbent upon me as an American surgeon to familiarize myself with political issues that will have a direct impact on the way I care for patients now and in the future.

I will definitely return to the ACS Advocacy Summit next year a bit wiser, a bit better informed, and certainly more determined to make our voices heard.

Daniel Klaristenfeld, MD, FASCRS, FACS
YFA Governing Council
Colorectal Surgeon
Kaiser Permanente Vandever Clinic, San Diego, CA


A Piece of My Mind: The Challenges and Rewards of Military Surgeons

You’ve probably seen us at meetings. We are the folks sitting at the ACS Clinical Congress in our interesting uniforms with shiny metallic buttons and variable assortments of colored ribbons where a breast pocket should live. You may have heard us speaking to one another in language littered with acronyms that mean very little to anyone not dressed in a similar fashion. You might even overhear our conversation of recent or pending “tours” to exotic locations.

"What are they doing here?" seems, to me at least, a natural question. We certainly may look a little different and even talk a bit different than the majority of College attendees. I think the short answer to that question is that we, like you, are surgeons. The daily elements of our job may vary a bit from your own practice, but we practice the same craft and share many of the same concerns. We fret about Maintenance of Certification. We wonder if that patient we operated on last week is going to be doing well on her next clinic visit. We struggle to balance work and family—just as many of you do.

There are, of course, challenges and concerns unique to the military surgeon. We may be called upon, sometimes at relatively short notice, to leave our friends and loved ones for lengthy periods of time. These trips may place us very much in harm's way. We may confront the burdens of heavy casualty care or, alternately, extreme boredom. That uncertainty alone represents a significant challenge.

The challenges are unique, but so, too, are the rewards. You don't have to be motivated by patriotism to appreciate that caring for soldiers, marines, sailors, and airmen is a fulfilling enterprise. Likewise, the opportunity to provide much-needed care to underserved host national patients presents experiences that will be cherished forever. Talk to military surgeons about their experiences and you will appreciate their perception of these rewards.

So why are we there sharing the College experience with you? The answer is best encapsulated in a single word familiar to all members of the College—Fellowship. It is a simple word. It implies exchange, interaction, and support. The lessons learned from our interactions with civilian peers make us better surgeons. These interactions improve our ability to care for unique populations under unique circumstances. The lessons we then learn, we make every attempt to process and exchange with our civilian colleagues. In this fashion the fellowship ring is perpetuated. It's a relationship that predates all those who are reading this now.

Find me or one of my oddly dressed colleagues at the ACS Clinical Congress. Don't let the ribbons and shiny metal buttons and ornaments separate us. Reach out a hand and we will shake it. You might just find that we have a lot more in common—in fellowship—than you think.

Joe DuBose, MD, FACS
YFA Governing Council
Lt Col USAF MC
Houston, TX