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Governor's Report
James A. Madura, M.D. FACS 2002
American College of Surgeons: Clinical Congress San Francisco, CA
Summary of the Governor’s Meetings October 6, 2002
The Board of Governors met Sunday October 6, 2002. Presentations were given by Edward Laws, Chairman of the Board of Regents, The current President of the ACS, R. Scott Jones, and J. Patrick O’Leary, Chairman of the Board of Governors. Additional comments were made by Dr. Tom Russell Executive Secretary of the ACS, Gay Vincent, comptroller of the ACS, and Tim Fabian, Treasurer of the ACS. Reports of the Governors Committees were also presented and acted upon.
The attendance at the ACS Meeting was 15,426, of whom 8791 were physicians.
Edward Laws, Chairman Board of Regents:
1. Announced that R. Scott Jones will assume the Chair for the Office of Evidence based Surgery. Its charge will be Research and Education. It will coordinate its efforts with Sam Wells and the Clinical Trials program.
2. A major concern is the declining numbers of applicants for surgical programs.
3. Duty hours restrictions remains a major concern for the College, and Committee will be convened in association with all Surgery Boards including those of the specialties.
R. Scott Jones, President of the ACS, described his new position as Chairman of the Division of Research and Optimal Surgical Care.
He described two clinical trials on non-cancer topics, concerning hernia repairs. These are nearly done and results should be forthcoming within the year.
The ACS is now working with the Veterans Administration on the Surgical
Quality Improvement program which has been quite successful in the VA system. The question is whether or not it can be transposed to the private sector. To that end, three University sites are participating in beta testing: Michigan, Kentucky, and Emory.
He then reviewed the success of the Journal of the ACS, now distributed to all members, making it the largest surgical subscription journal in the country.
Chapter activities are being looked at carefully to get more surgeons actively involved both locally and nationally. Visits by Officers and Staff of the ACS have been educational in both directions. Chapters have merged in smaller states, areas, etc.
The ACS is trying to encourage members to be proactive in public education and stimulation of our local legislatures.
Tom Russell, Executive Secretary of the ACS, is probably the major driving force in the ACS.
He reported that the Board of Regents has expanded from 19 to 22 members. New positions have been created for Vascular, Pediatric and Colorectal surgery.
There is a real effort to combine with other organizations like the AMA, SAGES, The American Society of General Surgery, and Surgical Specialty Societies to present a stronger combined voice.
Although all of organized medicine has been struggling with issues of reimbursement, the “opposition” is now the representatives of the elderly, i.e., the AARP, who are competing for the Medicare dollars for the drug prescription program. Tort reform passed the House of Representatives, (Greenwood), but may run into some opposition in the Senate.
Dr. Russell urged the membership to become more politically proactive. The ACS Web Site has an electronic activity center, requiring one to simply enter your zip code and letters will automatically be sent to your Reps. and Senators. There were 900 e-mails generated to legislators this summer by the members. The ACS feels that modification of the preformed letters may be more effective than a whole host of the same letter.
J. Patrick O’Leary, MD, Chairman Board of Governors, described his personal goals for the year 2002-2003 while he is still Chairman.
1. He reiterated the formation of the 501 C6 adjunct organization which will allow the ACS to become a political action force. Only $17 will be kept by the new political arm of the ACS. There will be an opportunity to contribute solely to the PAC on the dues notice.
2. He has helped developed an electronic quantifiable reporting mechanism for the Governors to respond to the ACS. 61% of the Governors did respond electronically this year.
3. Restructure and streamline the Governors’ Committee structure and to help them develop mission statements and goals for each committee.
4. Develop guidelines to assist Chapters with membership and educational activities.
5. Evaluate the duration of the annual Clinical Congress. In hard economic times, 5 or 6 days may be too much for the members to take away from their practices.
6. The Governors were asked to respond to a questionnaire based upon the most pressing issues of the past 20 years, and to judge whether each issue was better, worse of the same as last year. The top issues were: Declining reimbursement, Professional liability and malpractice issues, Medicare/Medicaid payment issues, and tort reform. All of these were thought by the respondents to be worse than last year. Other issues were felt to be less pressing and perhaps stable or a little better. These included: Managed care, Graduate Medical Education, Workforce issues such as current nursing shortages and probable surgeon shortages in the future, Healthcare reform such as EMTALA, OSHA, and HIPPA. Other less prominent issues were measurement of competency, funding for educational opportunities, Medical Education and research, credentialing for new technology, Peer review issues, Hospital privileging, and assistants in the operating room.
The Board of Regents responses to these concerns have been positive. Because of ACS efforts, Medicare cuts planned for next year may not occur. The cut was expected to be about 4% across the board. The flawed payment formulas are thought by HICFA to be “not correctable”. The ACS representatives continue to advise on the inequities of the system.
The medical liability issue is being address by Congress and some positive action both at the Federal and State level may happen soon.
For physicians in high risk states who are unable to afford or obtain liability insurance, the ACS has arranged a special deal with The Doctors Insurance Company, which may provide temporary coverage in certain states.
The resident working hours issue is now in place and some feel it is only a matter of time until the practicing surgeon has the same stifling regulation of working hours as well.
Tim Fabian MD, Treasurer of the ACS presented some bleak numbers due to the ACS investment package taking the same hit as everyone else because of the market decline. He urged all to consider a $1000 donation per year to the Fellowship fund. This covers the scholarships and other educational activities.
Lamar McGiness MD discussed the liaison he provides with the AMA and the “healing” process that has occurred with the ACS getting a louder voice in AMA circles. There are now 30 surgeons in the AMA House, and 8 surgeons on the Executive committee of the AMA. However, the AMA is having the same membership issues as everyone else. Only 22 of American surgeons belong to the AMA, and only 45% belong to the ACS. They also have declining membership in general, particularly among the younger MD’s.
The AMA also has the same priorities as we do. Professional liability and reimbursement are the top concern of the AMA at this time.
Additionally, the MA is considering moving its central offices to Washington DC in order to be in more of an advocacy position for its perceived major issues with Congress.
Important points from the Governors Committees Chairmen/Chairwomen:
1. The committee on blood borne pathogens and environment risk has been busy developing educational guidelines for civilian bioterrorism. Slide sets and online information are to be made available for the community surgeon to assist in taking the lead in public education.
2. Surgeons who are exposed to contamination from HIV+ patients should undergo prophylactic therapy. No patients have contracted HIV from any surgeon in the OR.
3. The Committee on Fiscal affairs re-emphasized the current financial problems because of the economy, and described the $4.8 million operating deficit. A motion was made by this committee to adjust dues to the rate of inflation (in addition to the $65 dues increase for the coming year) and this was overwhelmingly defeated by the Governors.
4. The Committee on Professional Health and Competency has produced a video on dealing with the disruptive surgeon, who is worse than the physician with a drug
or mental problem. This committee presented a proposal for random drug testing of all surgeons. After a vigorous discussion, this was roundly defeated.
5. The Committee on Socioeconomic Issues discussed the volunteer activities of the ACS membership. The report was based on a questionnaire which was in the Bulletin of the ACS. The respondents tended to be retired and usually volunteered for 4 weeks or more. The reasons given were mostly “it was the right thing to do”. It was recommended that the ACS create a “Volunteer of the Year” award.
Nominations & Elections:
Elected as new officers of the ACS:
Claude Organ MD FACS President-elect (Oakland, CA)
Anna Legerwood MD FACS. First Vice-President (Detroit, MI)
Murray Brennan, MD FACS Second Vice-President (New York, NY)
Elected as new members to the Board of Regents:
Charles D. Mabry, MD FACS (Pine Bluff, Arkansas)
Robin McLeod, MD FACS (Toronto, Ontario Canada)
Carlos Pellegrini, MD FACS (Seattle, WA)
Elected as Officers of the Board of Governors 2002-2003:
Chairman: Dr. J. Patrick O’Leary, MD FACS (New Orleans, LA)
Vice Chair: Timothy C. Fabian, MD FACS (Memphis, TN)
Secretary: Julie A. Freischlag, MD FACS (Baltimore, MD)
Member Executive Board: Mary M. Kemeny, MD FACS (Jamaica, NY)
My personal observations: The ACS is a large and growing bureaucracy. The hierarchy consists of:
Administration in the Chicago Office (Run by the Executive Secretary)
The Officers of the College
The Regents (the decision making body)
The Board of Governors
The Standing Committees of the College
There tends to be much redundancy and overlap in some of the duties of these various levels of governance without any overriding stewardship to keep everyone on the right track and attacking pertinent issues for the membership. Numerous committees are working on the same problems, and spinning their wheels. It is my opinion that some system of assigning problem areas should be done. Additionally, it is difficult for a relatively large committee to accomplish anything of significance when they meet at best, once or twice a year.
Finances will continue to be important, since the ACS has a large number of employees and limited ability to generate new income to support the infrastructure. Dues have been increased, but the income from the endowment has taken a hit from the stock market. There is little sympathy at the Governor level to further increase dues levels.
There is no doubt that the new direction of political advocacy will be an important and long overdue function. Since the ACS is the only real political voice that the practicing surgeon has, it is important that we recognize the value of this organization. If they are able to from a surgical (and/or all-MD) coalition than perhaps our voice could be heard as a powerful and meaningful force whose interests are those of the practicing surgeon, both urban and rural. This voice could act to allow the surgeon to continue to be an advocate for the improvement of care for their patients, and perhaps allow organized medicine to shed the image of a selfish money-oriented group.
Respectfully submitted,
James A. Madura, MD FACS
Governor-at-Large Indiana
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