Ductal Lavage Workshop
Chapter Visitation to Washington
 

 REFLECTIONS:
ADDRESS TO THE INDIANA CHAPTER OF
THE AMERICAN COLLEGE OF SURGEONS.
Michael C. Dalsing, MD, FACS

Webster defines reflection in several ways and in various contexts. It can be defined as "an effect produced by an influence", "a thought, idea, or opinion formed or a remark made as a result of meditation", or simply as "a consideration of some subject matter, idea, or purpose". It can be defined in the context of mathematics, or physics. But possibly the most enlightening definition is actually experienced by what one sees in the mirror of oneís own mind. For a cognitive person or group, that reflection will produce an effect, cause an opinion to be formed and instigate change if required. It makes one reevaluate oneís life, mission, goals, strengths and weaknesses. The reflections I will consider this morning concern the American College of Surgeons, The Indiana Chapter, and my personal journey and reflections within the context of these organizations.

The American College of Surgeons was founded in 1913 as an association of surgeons with the goal of improving the quality of surgical patient care. If one takes the time to read the Fellowship of Surgeons: A History of the American College of Surgeons by Dr. Loyal Davis, it becomes quite obvious that a few concerned and reflective surgeons drove the quest for excellence in surgery. Without these leaders who recognized the possibilities and strove for excellence, the status quo would certainly have been maintained. The earliest years were spent in attracting members and establishing an organization. Viewing the profession during this time in history, several glaring problems were evident. Possibly the most insidious yet potentially dangerous practice on several levels was the practice of fee splitting. The College actively condemned this practice over the protest of many within the surgical ranks. History eventually proved the College to be correct in this unpopular decision as other prestigious organization came to condemn this practice within their own ranks. Further reflection of medicine at the time demonstrated a wide diversity of care one could except to receive while in the hospital. In the late teens and early twenties of 1900, the College set standards for hospitals and inspected them to determine compliance. This action was a springboard that propelled the College onto the national scene. The Carnegie Foundation was so impressed by this effort to protect patients, that it provided funding at the level of $105,000.00 over 4 years to help initiate the screening process. Dr. Bowman in an address to the Board of Regents in December 1920 expressed a prevailing concern with medical practice. I quote "the usefulness of the College depends upon its power to project a better future in the science and practice of medicine and to assist in the realization of that future. Such a program of action concerns itself necessarily with principles, not dogmas; with principles to be tried, corrected, expanded, or rejected as, under the test of experience, they prove or fail to prove their value. It necessitates an alert open-mindedness to re-adjust ideas, and habits which have hardened through long years into custom". A response came in 1921 when a bone sarcoma registry was established to scientifically study this devastating clinical problem. This was the first practical research project sponsored by the College. Many others followed. Its work with postgraduate education began in 1919 with the naming of Dr. John G. Clark as chairman of a committee on postgraduate and research work. The Clinical Congress meetings had a major impact on the continuing medical education of practicing surgeons and on those in training. A more formal focus on the training surgeon came with the formation of the Committee on Graduate Training in Surgery in 1934. Some of the early work of the College has been assumed by the Joint Commission On Accreditation of Healthcare Organizations (JCAHO), The American Board of Surgery and the Accreditation Council for Graduate Medical Education (ACGME). However, the College still views these activities as vital to optimal patient care and has a significant voice in the workings of these regulatory bodies.

Over the years and through a process of continued reflection, the College has developed and modified committees to address ever-changing areas of concern. These committees provide an avenue for member input either as a committee member or by direct communication with those on the committee. Only by becoming involved can one expect to have an effect on the face of surgery in America. Age old concerns are maintained through the work of several committees including the Commission on Cancer, Committee on Operating Room Environment, Pre and Postoperative Committee, Committee on Graduate Medical Education, Committee on Trauma, Committee for the Forum on Fundamental Surgical Problems, the Committee on Continuing Education (i.e. the SESAP committee) and Surgical Research and Education Committee. The Committee on Development was formed to encourage membership in the Fellows Leadership Society and general philanthropic support. The International Relations Committee explores the means by which the College may improve its relations with surgeons throughout the world, especially in Latin America. The Committee on Allied Health Personnel is charged with developing, supporting and assisting allied health and allied medical personnel related to surgery and, when requested, to participate in defining their duties and assist in the processing of accreditation of the respective education programs. The explosion of technology has resulted in the formation of the Committee on Informatics, Committee on Medical Motion Pictures, and the Committee on Emerging Surgical Technology and Education. The recent national interest in promoting areas of medicine other than surgery which became reflected in a change in the medical school curriculum has made the Committee on Surgical Education in Medical School very important to the future of surgery. There has also been a keen awareness that the future leaders of surgery must be nurtured for a healthy College. The Committee on Young Surgeons studies ways to establish a mutual closeness with the Candidate Group and the younger Fellows, and to tap their energy for the activities of the College. The newest committee is the Committee on Minority Issues, which is charged with the study of educational, professional, and health-related issues related to underrepresented minority surgeons and patients, and will seek relevancy and support from the College for this effort.

During the June 2000 meeting of the Board of Regents the following mission statement for the College was approved:

"The American College of Surgeons, as an association of surgeons, is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. The College provides a cohesive voice addressing societal issues relating to surgery.

The American College of Surgeons supports programs and policies, which ensure patients access to high-quality, effective care provided by appropriately prepared and well-qualified surgical specialists of their choosing. Such care is to be delivered in a system that provides maximum safeguards for patient safety. Since 1913, the American College of Surgeons has initiated programs that have protected patients both in and out of the hospital. The American College of Surgeons will work with interested and qualified parties to provide patients with the maximum safety in a system that puts patient welfare first."

I feel as if the College is coming to terms with its role to speak for the 56,000 fellows and 3300 associate fellows within its ranks. It is the largest organization of surgeons in the world with an additional 3400 fellows in countries outside of the United States and Canada. Certainly political impact comes with constituent numbers and financial commitment. But the devil is in the details. The specialty and subspecialty interests within the organization makes fostering one political stance a potential benefit for one but possible detriment to another. However, without a strong political voice, the winds of political change will certainly favor those without an interest in the patientís well being. A newly appointed Health Policy Steering Committee held its first meeting in Washington, DC, on February 19 of this year. The committee will identify public policy issues and concerns affecting surgeons and their patients and coordinate ACS activities related to those issues. There has even been discussion of an ACS PAC or lobbying arm.

Reflecting on the needs of the members, several services have been created to help meet their needs. Some are quite familiar to everyone while others may surprise you. The College runs workshops on CPT and ICD-9 coding, as well as Practice Management Workshops (healthpolicyadvocacy@facs.org, 312-202-5213 or dmazmanian@facs.org). But did you know that The College has a coding hotline (800-ACS-7911). You have direct access to coding specialists specifically trained in procedural coding for your specific specialty. Fellows are given 10 consultation units in a 12-month period but then are required to pay for subsequent consultations. You can seek a job, list employment opportunities or fellowship opening, or practice opportunities on the Career Opportunities Position and Resume Data Bank (http://web.facs.org/jobs/toc.htm, 312-202-5231). The Surgical Research Clearinghouse is a listing of research scholarship, fellowships, and awards that are available from various surgical specialty societies (www.facs.org). You can get all the latest news form the College via the ACS NewsScope (acsnewsscope@facs.org). This is just a short list of the potential information readily available from the College.

The Indiana Chapter of the American College of Surgeons, having been chartered on November 3,1952,

is slightly younger than the speaker. Its major emphasis has been the continued education and fellowship of surgeons within the state. In the 1970ís, under the direction of Dr. John E. Jesseph, three meetings each year in addition to the Annual Meeting of the chapter was sponsored jointly through the Chapter and the Indiana University Department of Surgery. Two of these three meetings have been retained as the winter meeting in conjunction with the John Jesseph Lecture, in honor of Dr. Jesseph, and the fall meeting in conjunction with the Will C. Moore Lecture. The Annual meeting held in the spring is the premiere gathering we are currently experiencing. Each provides an opportunity to meet friends and to learn what is new nationally and locally in surgery. These activities are alive and vital as obvious to those in attendance today.

The Indiana Chapter of the American College of Surgeons is a prime vehicle for admission to the inner workings of the College. It provides the Indiana surgeon with the opportunity to reflect on his/her role within the broader scope of surgery. It will also provide practical solutions to everyday concerns via a prospective mechanism if one is willing to dedicate the time and effort. The chapter has twelve committees generally consisting of a chairman and one or more volunteer members. The committees are Trauma, Young Surgeons, Program, Nominating, Membership, Legislative/Socioeconomic, Communications, Chapter Development, Cancer, Bylaws, Auditing, and Chapter Liaisons. Each is open to new ideas, and extended membership for those who wish to impact surgery within Indiana. There is also a Board of Councilors consisting of 15 members who help to advise the president, president-elect, and secretary-treasurer. Five councilors are elected each year for terms of three years. Two Governors, nominated by the chapter and elected by the Fellows at the Clinical Congress of the College, together with the past-president complete the Board of Councilors.

The impact of the Indiana Chapter in the eyes of many within the state has matured over the years reflected in the duties the Chapter members have been asked to perform. Many of these opportunities to impact local surgery and medicine have come about through the chapterís status as an organization that represents surgeons within the state. We have a voice in the regional Medicare Advisory Board (AdminiStar Federal) through the presence of three members from our organization. The Indiana Chapter is yearly requested to submit names for consideration as potential members to sit on the National Committees as positions open. The College is very interested in a grass-roots effort to impact local and national politics. They have designated several full-time staff member to help in this regard and to provide anyone interested with valuable information. The contact person in Chicago is Jon Sutton (jsutton@fasc.org, 312-202-5358) and in Washington, Christopher Gallagher (cgallagher@facs.org) and Christian Shalgian (cshalgian@facs.org). We are invited yearly to visit Capitol Hill in the Colleges effort to impact the political system at a grass-roots level via Indiana representatives and senators. We have members active within the Indiana American Medical Association. Support for efforts of other Chapters are often solicited from our Chapter. I could continue but I believe you get the idea. Members interested in these activities are cordially invited to submit their names.

As a personal reflection on my year as president of the Chapter, I have attempted to instigate some new focus and to extend that begun by my predecessors. I have attempted to stress some socioeconomic efforts. We have increased from 1 to 3 active members on the Advisory Medicare Board for our region. Everyone should receive ACS NewsScope by e-mail to keep abreast of the issues facing the College. Everyone should be aware of the grass-roots effort to influence local and even national politics through personal contacts. As I mentioned previously, there are full-time staff members of the College dedicated to this effort. Anyone interested in representing the College at an Indiana visit to Washington should let us know of this interest. Our Legislative/Socioeconomic Committee keeps us abreast of the workings of the Indiana AMA and its legislative efforts which are tabulated in our meeting minutes and when pertinent on the web site. Early in the year, we had some discussion of allocating a portion of our dues to political efforts but found this unwise due to tax issues dealing with political contributions. The grass roots effort of communicating directly with political figures known to the members may be a more effective and efficient method of impacting our political environment. My hope is that a continued effort on the socioeconomic and legislative front be stressed by the Chapter as it reflects on its own role within the state and nation.

I have also made a concerted effort to improve the spring meeting attendance by inviting the regional state American College of Surgeons selection committees to interview prospective new Fellows at the spring meeting. Dr. Gross and his committee have accepted this invitation and will be conducting interviews at this venue on Saturday. It is my hope that the prospective Fellows from Indiana will thereby connect the superb activities of the Chapter with its parent College and their membership. I have personally contacted a majority of the exhibitors present at the meeting for their support. Such support allows for a full range of activities and resident participation in the meeting. The concept of a door prize to attract interaction between our exhibitors and our members I hope was a successful endeavor to allow optimal interact between our members and their industrial and pharmaceutical suppliers.

Attracting new members is a constant goal stressed by all my predecessors. In our Council meetings, we have discussed establishing a foundation fund to help residents to attend meetings and become involved with the Chapter early in their careers. We have established such a mechanism for this funding with the Council members each pledging a significant contribution to initiate this effort. However, simple reflection upon how each of us became personally involved with the Chapter may provide an even more direct solution. I think we all realize that personal contact involving some aspect of role modeling and a personal invitation to join with us are the most successful membership recruitment techniques. I would hope that all present here would invite at least one other surgeon to attend our next meeting and really encourage that participation.

Upon reflection, it is obvious to me that the good and generous people who represent the College in Indiana have made this year and past years a wonderfully pleasant experience for me personally. Drs. Madura and Inlow have admirably fulfilled the role of Governor in recent years. Their summaries of the Annual Governorís Meeting of the American College of Surgeons have kept us abreast of the most recent effort at reflection by the College and their proposals to improve areas of concern. Dr. Inlow plans to retire later this year, he has proven to me that not only can a "mature/old" dog learn new trick but also that he can actually teach others these new tricks. His management and initiation of your Indiana Chapter ACS website was so impressive that he has been requested, more than once, to teach a course in this skill at College events in Chicago. Drs. Bob Pennington and Mike Sadove, my immediate predecessors, provided valued support under my short tenure. Dr. Scherer has admirably and effectively maintained an organized and financially sound ship. All fifteen councilors, who represent constituents scattered through out the state, have provided effort and support beyond their required roles for which I am truly grateful. Dr. Mary Aaland was instrumental in establishing the local arrangements for this excellent meeting. Each Committee chairman and his members have maintained and advanced the influence of the Chapter within the state and within the College and must be commended. Dr. Wayne Moore has assumed the editorial position of our Newsletter, a role that allows him to inform our members of Chapter activities and other pertinent news. Dr. Stephen Lalka and Alan Sawchuk, as Program Committee chairmen, have arranged a superb meeting with pertinent panel discussions, invited guests, member papers and resident presentations. Last but not least, I would like to thank Carolyn Downing for her efforts on behalf of the Chapter throughout the year. Her hard work makes it quite easy for the rest of us.

It has been an active year and a fruitful year. My personal association with the Indiana Chapter of the American College of Surgeons reflects a time of growth; I hope accomplishment; and certainly fellowship. It has been by distinct honor to have served the Chapter and, each of you personally, as its 49^th president. Reflect on your own role within surgery, and get involved. With Dr. Graffis at the helm and assisted by the Board of Councilors, an even brighter future for the coming year is inevitable especially if you personally take an active role.

Reflecting on the needs of the members, several services have been created to help meet their needs. Some are quite familiar to everyone while others may surprise you. The College runs workshops on CPT and ICD-9 coding, as well as Practice Management Workshops (healthpolicyadvocacy@facs.org, 312-202-5213 or dmazmanian@facs.org). But did you know that The College has a coding hotline (800-ACS-7911). You have direct access to coding specialists specifically trained in procedural coding for your specific specialty. Fellows are given 10 consultation units in a 12-month period but then are required to pay for subsequent consultations. You can seek a job, list employment opportunities or fellowship opening, or practice opportunities on the Career Opportunities Position and Resume Data Bank (http://web.facs.org/jobs/toc.htm, 312-202-5231). The Surgical Research Clearinghouse is a listing of research scholarship, fellowships, and awards that are available from various surgical specialty societies (www.facs.org). You can get all the latest news form the College via the ACS NewsScope (acsnewsscope@facs.org). This is just a short list of the potential information readily available from the College.

The College is very interested in a grass-roots effort to impact local and national politics. They have designated one full-time staff member to help in this regard and to provide anyone interested with valuable information. The contact person in Chicago is Jon Sutton (jsutton@fasc.org, 312-202-5358) and in Washington, Christopher Gallagher (cgallagher@facs.org) and Christian Shalgian (cshalgian@facs.org).