Bulletin July 2007
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JULY 2007 Volume 92, Number 7 FEATURES Stephen J. Regnier From the Chair of RAS-ACS: Editor The voices of young surgeons 8 Gregory S. Cherr, MD Linn Meyer Removing our loupes: Encouraging surgeons to develop Director of a broader perspective for the future 11 Communications C. Suzanne Cutter, MD The future of the American College of Surgeons: Karen Stein Uniting two perspectives 14 Associate Editor Ted A. James, MD, and Thomas R. Russell, MD, FACS Diane S. Schneidman The road to innovation: Emerging technologies in surgery 19 Carlos M. Mery, MD, MPH; David T. Cooke, MD; Venita Chandra, MD; Contributing Editor Bilal M. Shafi, MD, MSE; Ali Tavakkolizadeh, MD; and Thomas K. Varghese, Jr., MD (edited by Dr. Mery and Dr. Cooke) Tina Woelke Graphic Design Specialist The globalization of surgery: Surpassing the frontiers 34 Mecker G. Möller, MD; John Karamichalis, MD; and C. Suzanne Cutter, MD Alden H. Harken, International medical graduates in American surgery: MD, FACS Past, present, future 39 Charles D. Mabry, Dean R. Cerio, MD; and Cyrus F. Loghmanee, MD MD, FACS New trends and developments in fellowship training 43 Jack W. McAninch, MD, Heena Santry, MD; and C. Suzanne Cutter, MD FACS New ways of practicing surgery: Alternatives and challenges 51 Editorial Advisors Mecker G. Möller, MD; Luis A. Santiago, MD; John Karamichalis, MD; and Joshua M. V. Mammen, MD Tina Woelke Front cover design Congressman Michael Burgess, MD: The necessity of physician involvement in the political process 59 Shawn Friesen College recognizes ACS NSQIP hospitals 65 Future meetings 2007 Clinical Congress preliminary program 67 Clinical Congress DEPARTMENTS 2007 New Orleans, LA, October 7-11 From my perspective 4 Editorial by Thomas R. Russell, MD, FACS, ACS Executive Director 2008 San Francisco, CA, October 12-16 Dateline: Washington 6 Division of Advocacy and Health Policy 2009 Chicago, IL, October 11-15 On the cover: The Resident and Associate Society of the American College of Surgeons addresses issues pertinent to residents in a series of articles on pages 8-58. Photo courtesy of Punchstock. NEWS Bulletin of the American College of Surgeons (ISSN Dr. Pierce receives Jacobson Award 84 0002-8045) is published monthly by the American Col- Resident Research Scholarships for 2007 awarded 87 lege of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It 2007 Health Policy Scholars announced 89 is distributed without charge to Fellows, to Associate Fellows, The Clowes/ACS/AAST/NIGMS to participants in the Candi- Mentored Clinical Scientist Development Award available 90 date Group of the American College of Surgeons, and to ACOSOG news: medical libraries. Periodicals postage paid at Chicago, IL, ACOSOG Z9001 completed 91 and additional mailing offices. David Ota, MD, FACS; and Heidi Nelson, MD, FACS POSTMASTER: Send address changes to Bulletin of the Operation Giving Back: American College of Surgeons, Volunteer opportunities available 92 633 N. Saint Clair St., Chicago, IL 60611-3211. Canadian Pub- A look at The Joint Commission: lications Mail Agreement No. Low health literacy puts patients at risk 94 40035010. Canada returns to: Station A, PO Box 54, Windsor, NTDB® data points: ON N9A 6J5. The rockets’ red glare 95 The American College of Richard J. Fantus, MD, FACS, and Joshua Fantus 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 endorse- ment by nor official policy of the American College of Sur- geons. ©2007 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. AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION • SYLLABI SELECT: The content of select ACS Clinical Congress postgraduate courses is available on CD-ROM. BASIC ULTRASOUND COURSE: This course has been developed on CD-ROM to provide the practicing surgeon and surgical resident with a basic core of education and train- ing in ultrasound imaging as a foundation for specific clinical applications. It replaces the basic course offered at the Clinical Congress and is available for CME credit. PROFESSIONALISM IN SURGERY: CHAL- LENGES AND CHOICES: This CD presents 12 case vignettes, each including a scenario followed by multiple-choice questions related to professional responsibilities of the surgeon within the context of the case. The program provides a printable CME certificate upon successful completion. PERSONAL FINANCIAL PLANNING AND MANAGEMENT for Residents and Young Sur- geons: This CD uses an interactive/lecture format to equip residents and young surgeons with the knowledge to manage their personal financial future, including debt management and financial planning for surgical practice. This program provides a printable CME certificate upon successful completion. PRACTICE MANAGEMENT for Residents and Young Surgeons: This CD uses an interactive/lecture format to equip residents and young surgeons with the knowledge to manage their surgical future, including how to select a practice type and location, the mechanics of setting up or running a pri- vate practice, the essentials of an academic practice and career pathways, and surgical coding basics. This program provides a printable CME certificate upon successful completion. BARIATRIC SURGERY PRIMER: This CD addresses various aspects of bariatric surgery, including the biochemistry and physiology of obesity, appropriate candidates, basic bariatric procedures, comorbidity and outcomes, and surgical training, as well as facilities, managed care, liability NEW: DISCLOSING SURGICAL ERROR: issues, and ethics. VIGNETTES FOR DISCUSSION: This DVD demonstrates two approaches used by a surgeon to disclose to the patient’s ONLINE CME: Courses from the ACS’ Clinical Con- family a major technical error that occurred in the operating room. gresses are available online for surgeons. Each online course The vignettes demonstrate effective disclosure techniques, as well features a video introduction, slideshow presentations with as approaches that need improvement. This project was supported synchronized audio of session, printable written transcripts, by a grant from the Agency for Healthcare Research and Quality and printable CME certificate upon successful completion. The and is available at no cost. courses are accessible at www.acs-resource.org. For purchase and pricing information, call ACS Customer Service at 312/202-5474 or visit our E-LEARNING RESOURCE CENTER at www.acs-resource.org For more information contact Olivier Petinaux, MS, at [email protected], or tel. 866/475-4696. All-Products-Ad-Bulletin-(revise1 1 3/15/2007 3:50:16 PM From my perspective any surgeons and other medical pro- fessionals apparently are getting the message: Our nation’s health care sys- Mtem is on the verge of historic reform, and either we contribute to efforts to stimulate the delivery of value-based care, or we will suffer the repercussions of regressive thinking. In light ’’ of recent developments, I thought it worthwhile to review some of the innovative approaches to patient care that surgeons and other stakehold- ers are testing and bringing to the negotiating table. Key concepts under discussion are intended I thought it worthwhile to to improve efficacy and efficiency in health care through better-coordinated care; pay for compli- review some of the innovative ance with evidence-based guidelines; and fewer costly, unsupported medical treatments. approaches to patient care that Continuous, coordinated care surgeons and other stakeholders Most patients and their physicians would agree that medical care today lacks continuity—that are testing and bringing to patients too often see subspecialist after subspe- cialist and receive little guidance in their attempts the negotiating table. to navigate our fragmented health care system. Some experts believe that more coordinated and comprehensive care aimed at treating the whole ’’ patient will reduce the complications associated Physicians, the American Academy of Family Phy- with hand-offs and poor cross-specialty commu- sicians, and the American Osteopathic Association nication. Under a model that accommodates more have recently proposed the development of the continuous care, surgeons and other physicians “advanced medical home.” Under this proposal, would lead teams of high-performance health patients would secure the services of “personal care professionals. These teams would function physicians,” who would be responsible for ensur- within multidisciplinary centers, where medical ing that patients have access to a coordinated team professionals work together to provide consistent, of specialists. Other aspects of this plan deal with cost-effective patient care. pay for performance and related reimbursement The Mayo Clinic’s Gonda Vascular Center