ACS President to Initiates: A surgical career is a joy and a privilege

Barbara Lee Bass, MD, FACS, FRCS(Hon)
Barbara Lee Bass, MD, FACS, FRCS(Hon)

“What we get to do for the people who need us, our patients, is a joy and a privilege,” said Barbara Lee Bass, MD, FACS, FRCS(Hon), newly installed President of the American College of Surgeons (ACS) in her address to nearly 900 of the College’s 1,827 Initiates during Convocation Sunday evening. “What we have earned the privilege to do is an honor—a trust-filled act with another person.”

Dr. Bass acknowledged the unparalleled professional and personal demands of surgical training, including “sleepless nights, thousands of hours in the hospital, and endless hours of study,” and she described the rewards of this experience as well. “You were learning—a lot. You were doing remarkable things with your hands and minds. You were developing fundamental and then advanced surgical skills. You were learning about human kindness, anger, frustration, and joy. You were building that remarkable portfolio of skills that we call surgery.”

“No matter where in the world you experienced this pathway to becoming a Fellow—and we have surgeons from [approximately] 70 nations joining our College tonight—this transformation from student to surgeon is a magnificent, shared experience for all of us,” Dr. Bass said.

The Initiates could have chosen another profession, “but, no, surgery chose you, and you dove in,” Dr. Bass said. “As I tell my residents, we aren’t surgeons because we want to be. We are surgeons because our communities need us to be.”

Dr. Bass reminded attendees of the trusted bond between a surgeon and a patient, and she urged physicians to use this profound connection to revitalize their commitment to their work. “[This bond] can get lost in fatigue, lost in excessive regulatory burdens, lost in the electronic health record, which can truly bring me to tears of exhausted frustration,” she said.

“You will age. You will become ill at some time or another,” she added. “That you may stumble is not a sign of weakness. It’s life.” Successfully combating fatigue necessitates the development of personal coping strategies, but Dr. Bass also underscored the value of professional resources as a mechanism to curb burnout.

“It is the responsibility of our professional organizations to craft solutions, or at least bumpers, to soften the impact and enhance personal performance and wellness as we face these challenges,” Dr. Bass said.

Although the role of women in surgery has continued to evolve since the profession first laid claim to Dr. Bass nearly 40 years ago, inequities between women surgeons and their male counterparts remain a reality, she noted. A sharp look at the situation shows that women surgeons are still compensated less for equal work than their male colleagues, noted Dr. Bass. “Are these disparities because of poor negotiation skills, diminished personal expectations, implicit bias from prospective partners and health care organizations, or overt residual inequity? The answers are unclear—but the data speak clearly.”

Women are less likely to rise to leadership roles in their group practices, hospitals, and professional organizations, or to advance through academic ranks, according to Dr. Bass. “The ripple effect of this disparity is passed on to our students, who don’t see women surgeons in leadership roles, but rather as entry-level young surgeons who are extraordinarily stretched thin with numerous demands at perhaps the busiest time of their lives as long-deferred children begin to arrive,” she said.

Dr. Bass noted that the ACS has responded to these concerns in recent years, issuing statements about gender pay equity and parental leave.

Similarly, the College has responded to advances in surgical technology, including the introduction of minimally invasive approaches to surgery. Examples include the development of the Committee on Emerging Surgical Technology and Education and the ACS Accredited Education Institutes, which certify training centers that use simulation technology to improve the skills of surgical trainees and practicing surgeons who are learning to perform new and advanced procedures.

“The ACS was founded in 1913 by a group of surgeons with the explicit goal of improving the care of the surgical patient. This remains our purpose today,” noted Dr. Bass, underscoring the power of individual surgeons working together, across specialties, to effect change. She highlighted key education and quality programs in the College, including the Committee on Trauma and its Advanced Trauma Life Support® (ATLS®) program, the ACS trauma verification system, and the ACS military partnerships, which are intended to translate lessons of warfare to the care of the civilian injured.

Dr. Bass also described the vital role of the ACS National Surgical Quality Improvement Program (ACS NSQIP®), which originated in the Department of Veterans Affairs under the leadership of Shukri Khuri, MD, FACS, as the world’s largest surgical quality measurement and improvement system.

“Through this program, an army of surgeons and other health care providers now collaborate with a sharp focus on surgical quality, all in the hopes of saving patient lives,” she said. “Examples like this are endless, [where a] surgeon identifies a gap and—with a good idea and the abundant ACS infrastructure—a valuable new program is made. Other examples of College programs that were born of one surgeon’s identification of a gap include the Surgical Education and Self-Assessment Program, the aforementioned ATLS program, Fundamentals of Surgery, the Journal of the American College of Surgeons, and most recently, the Optimal Resources for Surgical Quality and Safety, which will soon be our guiding manual for all aspects of surgical care delivery in our ever-changing health care system.”

“I want to close with a request—and it is a hard one,” Dr. Bass told the Initiates. “I want you to be aware of your colleagues. I want you to watch them for signs of stress and disturbances in their abilities. And, if you see something, please offer to chat—a supportive question, an offer of assistance. We need to start the dialogue with someone who may be in trouble; we need to be proactive. Be aware of help that is available in your institution and know how to move a concern up the chain with sensitivity, but also with compassionate concern for your colleague.”

Dr. Bass called for the removal of the stigma associated with depression, substance abuse, and mental illness. “Yes, these things happen to us, we professional women and men, and we need to start a discussion to determine if together we can create a new net to extract those colleagues in harm’s way without judgment,” she said.

“But, for now, I hope you are excited and happy in your near future. I hope you are proud of your new Fellowship in the ACS. I hope you will draw endless support and friendship from those around you and that you will contribute more than you receive. And I hope that you will forever treasure your opportunity to practice surgery—an exceptional joy and privilege,” Dr. Bass said.