JULY 2009 Volume 94, Number 7 FEATURES Stephen J. Regnier Does the U.S. have the best Editor health care system in the world? 8 Linn Meyer Ronald D. Wenger, MD, FACS Director, Division of Integrated Communications ACS promotes the six competencies of the Accreditation Council for Graduate Medical Education 16 Tony Peregrin B. J. Palmer, MD; Victor Stams, MD; Thomas R. Russell, MD, FACS; Associate Editor Alden H. Harken, MD, FACS; and L. D. Britt, MD, FACS Diane S. Schneidman Karen Stein Equipment for ambulances 23 American College of Surgeons Committee on Trauma, American College Contributing Editors of Emergency Physicians, National Association of EMS Physicians, Tina Woelke Pediatric Equipment Guidelines Committee–Emergency Medical Services Graphic Design Specialist for Children Partnership for Children Stakeholder Group, and American Alden H. Harken, Academy of Pediatrics MD, FACS Governors’ Committee on Chapter Activities: An update 30 Charles D. Mabry, Lenworth M. Jacobs, Jr., MD, MPH, FACS MD, FACS Jack W. McAninch, Residents salute their mentors 32 MD, FACS Editorial Advisors My mentor: The persistent calm: Anthony Stallion, MD, FACS 33 Tina Woelke Kaine C. Onwuzulike, MD, PhD Mary Beth Cohen My mentor: Front cover design The ideal surgical mentor: R. Anthony Perez-Tamayo, MD, FACS 34 Daniel Eiferman, MD Future meetings 2009 Clinical Congress Preliminary Program 35 Clinical Congress 2009 Chicago, IL, October 11-15 DEPARTMENTS 2010 Washington, DC, October 3-7 From my perspective 4 2011 San Francisco, CA, Editorial by Thomas R. Russell, MD, FACS, ACS Executive Director October 23-27 What surgeons should know about... 6 The surgical CAHPS survey Letters to the Editor should Elizabeth W. Hoy, MHA be sent with the writer’s name, address, e-mail ad- Socioeconomic tips 52 dress, and daytime tele- ACS Coding Hotline: Operative report questions phone number via e-mail to [email protected], or via mail John T. Preskitt, MD, FACS; Albert Bothe, Jr., MD, FACS; Linda Barney, MD, to Stephen J. Regnier, Editor, FACS; Mark T. Savarise, MD, FACS; and Debra Mariani, CPC Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or On the cover: Program and registration information for the College’s annual clarity. Permission to publish letters is assumed unless the Clinical Congress appears beginning on page 35. This year’s meeting will take author indicates otherwise. place October 11–15 in Chicago, IL. NEWS Bulletin of the American College of Surgeons (ISSN In memoriam: 0002-8045) is published Former ACS Director Paul A. Ebert, MD, FACS 54 monthly by the American Col- Constantine Mavroudis, MD, FACS lege of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It 2009 Health Policy Scholars announced 60 is distributed without charge to Fellows, Associate Fellows, Visit the ACS Web portal’s rural surgeons community 62 Resident and Medical Student Members, Affiliate Members, A look at The Joint Commission: and to medical libraries and al- lied health personnel. Periodi- Improve hand hygiene with free monograph 63 cals postage paid at Chicago, IL, and additional mailing Correction 63 offices. POSTMASTER: Send address changes to Bulletin of Clinical congress sessions to present research in progress 65 the American College of Sur- geons, 633 N. Saint Clair St., New College Web site centers on Chicago, IL 60611-3211. Cana- E-prescribing Incentive Program 65 dian Publications Mail Agree- ment No. 40035010. Canada NTDB® data points: Falling down 67 returns to: Station A, PO Box Richard J. Fantus, MD, FACS 54, Windsor, ON N9A 6J5. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. 312/202-5000; toll-free: 800/621-4111; fax: 312/202- 5001; e-mail:postmaster@ facs.org; Web site: www.facs. org. Washington, DC, office is located at 1640 Wisconsin Ave., NW, Washington, DC 20007; tel. 202/337-2701, fax 202/337-4271. Unless specifically stated otherwise, the opinions ex- pressed and statements made in this publication reflect the authors’ personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2009 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmit- ted in any form by any means without prior written permis- sion of the publisher. Library of Congress number 45-49454. Printed in the USA. The American College of Surgeons is dedicated to improving the care of the sur- Publications Agreement No. gical patient and to safeguarding standards of care in an optimal and ethical 1564382. practice environment. From my perspective he Chair of the American College of Sur- geons’ Board of Regents, L.D. Britt, MD, MPH, FACS, classifies the geographic, Teconomic, and ethnic disparities in the U.S. health care delivery system as the civil rights issue of this era. I agree wholeheartedly. Too often patients receive lower-quality care, have ’’ greater difficulty accessing medical services, or have to pay more for treatment simply because of demographics. These variances have no place in a humane and just society and are ethically and morally antithetical to the medical and The need to address disparities surgical professions, which are grounded in the principle that all patients deserve to be treated in care—especially ethnic with compassion and respect, regardless of race, location, or income. and racial divides—is growing Persistent problems increasingly urgent. Whereas the U.S. has made some significant strides in eliminating disparities in access to mammograms, smoking cessation counseling, ’’ and appropriately timed antibiotics, many of the most significant disparities persist. For ex- at least twice as unlikely to visit a physician as ample, African-Americans are more likely than insured patients. Furthermore, Hispanics and are Caucasians to be admitted to the hospital African-Americans have differential access to a for lower extremity amputations due to diabetes primary care physician or specific source of care, and are less likely to receive appropriate pre- with Hispanics at particular risk.† natal care during the first trimester of pregnancy. Regardless of race or ethnicity, low-income Native Americans also are less likely to receive people receive less patient-centered, continuous prenatal care, and they are less likely to undergo care. For example, the percentage of patients who colon-rectal cancer screening. Meanwhile, Asian- have their blood under control is significantly Americans are less likely than whites to receive lower for poor than for high-income people, and timely care for an illness or injury, and Hispanics low-income individuals are much less likely to are three times more likely to contract AIDS.* receive recommended care for colon cancer. Low- Under our current system, access to health income Americans also are two to three times as care is largely determined by whether an in- likely as high-income individuals to report prob- dividual has health insurance, and minority lems receiving timely treatment. Furthermore, populations are far more likely to lack coverage. poor Americans are less likely to have a specific Among nonelderly adults, at least 36 percent of source of ongoing care.* Hispanics and 33 percent of Native Americans Geographic variances also are notable. For ex- are uninsured. In addition, 22 percent of African- ample, there was nearly a 20 percent gap in the American, 17 percent of Asian, and 13 percent of proportion of nonelderly Minnesotans and Tex- white adults are uninsured. Adults in all racial/ ans who were uninsured in 2004–2005. There also ethnic groups who lack insurance coverage are is wide variability across state lines in the odds of *Agency for Health Care Quality and Research. National a patient undergoing certain common Medicare Healthcare Disparities Report, 2008. Available at http://www. procedures, such as carotid endarterectomy, cho- ahrq.gov/qual/nhdr08/nhdr08.pdf. Accessed May 13, 2009. lecystectomy, colectomy, aortic aneurysm repair, †The Henry J. Kaiser Family Foundation. Eliminating Racial/ Ethnic Disparities in Health Care: What Are the Options? and back surgery. Available at http://www.kff.org/minorityhealth/h08_7830.cfm. In addition, rural patients have less access to Accessed May 13, 2009. appropriate care than their counterparts in met- 4 VOLUME 94, NUMBER 7, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS ropolitan areas. Indeed, more than 25 percent of the health care professions, medical schools need Americans live in communities with fewer than to provide opportunities for positive interaction 50,000 residents, but only nine to 12 percent of among individuals from a range of backgrounds. surgeons practice in nonmetropolitan areas.‡ A multicultural environment forces people to challenge their assumptions about individuals Possible solutions from different backgrounds and broadens their The need to address disparities in care— worldview. especially ethnic and racial divides—is growing Most importantly, however, we need to change increasingly urgent. If these variances in care our professional culture. We need to place greater continue unchecked, many more Americans will emphasis on the tenets of our noble calling: to be at needless risk of requiring costly emergency provide the best possible, ethical, and compas- and acute or end-of-life care, thereby threaten- sionate care to all who people who entrust us ing our nation’s economic and moral fabric.