Valerie W. Rusch, MD, FACS, the 100th President of the American College of Surgeons (ACS), urged the nearly 1,000 Initiates at Clinical Congress 2019 Convocation on Sunday, October 27, to uphold the values passed on for generations of surgeons—to commit to lifelong learning, to collaborating, and to giving back. She noted that dedication to these professional principles benefit both the surgical patient as well as surgeons who might be feeling the strains of modern-day practice.
“Each of us stands on the shoulders of our predecessors, both professionally and personally,” according to Dr. Rusch, vice-chair, clinical research, department of surgery; Miner Family Chair in Intrathoracic Cancers; attending surgeon, thoracic service, department of surgery, Memorial Sloan-Kettering Cancer Center; and professor of surgery, Weill Cornell Medical College, New York, NY. “Each of us is influenced and elevated by our predecessors, mentors, colleagues, hospital staff, friends, and family.”
Dr. Rusch noted that her parents “steadfastly instilled several important life principles, which have stood me in good stead throughout my career. First, was the supreme importance of education.”
Her parents, she said, “remained avidly interested in the changing world around them and were good examples of lifelong learning.” Her parents also instilled in their children the value of hard work, integrity, and the pursuit of excellence.
“High levels of achievement were expected,” Dr. Rusch said. “At one point early in my medical career when I was talking with my father [who also was a physician] about the difficulties of being among what was then a very small number of women in surgery, his simple answer was, ‘No one can argue with excellence.’ End of discussion.”
Another value that her parents espoused was “a commitment to equality irrespective of race, ethnicity, religion, or gender,” Dr. Rusch said. Both of her parents were politically active in the turbulent period of the 1930s through the 1960s, and her mother “was a feminist before the term came into common use and regularly asserted that there should be no barriers to women achieving their highest professional ambitions. Both of my parents emphasized the rewards and importance of being involved in activities that extended beyond oneself and in some way benefited others.
“I believe that these principles would stand any of us in good stead professionally and personally, and they parallel many of the principles upon which this College was founded and functions today,” she added.
Dr. Rusch noted that this year’s Initiate class represents the largest number of new ACS Fellows and reflects the increasing diversity of the organization’s membership. “Today, roughly 30 percent of new Fellows are women, 40 percent work outside of North America, and 40 percent practice in specialties other than general surgery. As I look around this auditorium, I see diversity in gender, race, ethnicity, and countries of origin. This diversity not only strengthens the College as an organization, but benefits our patients,” she said.
New Fellows of the College are in the early phase of their careers “at a time that could not be more exciting. In fact, as I witness recent extraordinary scientific and technological advances, I wish that I, too, were just starting my career,” she said. For example, as a surgical oncologist, Dr. Rusch has, in the last 15 years, “seen a rapid evolution in our understanding of fundamental tumor biology and the development of many novel therapies—either therapies targeting specific mutations or immunotherapy with checkpoint inhibitors, leading to more precise treatment with far better outcomes.”
Ensuring that these types of advances are used in ways that truly benefit patients requires that surgeons be nimble in their thinking, adaptable in learning new techniques and technologies, collaborative in their work, and rigorous in evaluating outcomes. “‘Lifelong learning,’ ‘team science,’ ‘team care,’ and ‘quality care’ have become overly popular bywords, but they are indeed now central to achieving clinically meaningful progress,” Dr. Rusch said.
The rapid pace at which change is occurring in health care, however, is creating new challenges for surgeons, leaving some surgeons feeling overwhelmed and isolated. “Recent studies report that burnout affects 30 to 50 percent of residents and practicing surgeons, with perhaps surgical residents and women being at greatest risk,” Dr. Rusch said.
“While the factors responsible for this situation are not fully understood, increasing administrative and documentation demands, the loss of personal autonomy related to the corporatization of medicine, long work hours, and work-life imbalance are consistently cited as culprits,” she noted. Furthermore, surgeons in the U.S. are burdened with “a highly resourced but also highly politicized and dysfunctional health system with many disparities in care. It is thus easy to focus on the daily frustrations of our work environment while losing sight of the great opportunities to improve the care of our patients,” Dr. Rusch said.
To move forward under these challenging circumstances, Dr. Rusch encouraged surgeons to collaborate and participate in efforts that address a common need or common good. These efforts can lead not only to more effective patient outcomes, but also can be personally rewarding, she said, noting that “the ACS provides a unique environment for the multidisciplinary collaboration that is needed to ensure the highest quality care for our patients.”
The ACS has more than a century’s experience in establishing and running programs designed to ensure high quality patient care in cancer, trauma, bariatric, pediatric, geriatric, and other surgical specialties. All ACS Quality Programs follow four principles: establish evidence-based standards that can be individualized by patient; ensure an optimal infrastructure is in place; assess outcomes through rigorous data extraction and analysis; and use external peer-reviewed verification to ensure quality is sustained.
“Ample published data show that these Quality and Verification programs are successful in improving patient care. For instance, the development of standards for bariatric surgery and an ACS program of accreditation for bariatric programs directly led to a significant national decrease in operative mortality,” Dr. Rusch said.
In recent years, the College has been expanding its international reach, bringing educational programs such as the Advanced Trauma Life Support® program to all corners of the world and providing scholarships that enable international surgeons to support their academic work, to travel to the Clinical Congress, and to visit institutions in North America.
“One of the ACS programs that speaks to the highest ideals of our profession is Operation Giving Back (OGB), which seeks to leverage the passion, skills, and humanitarian ethos of the surgical community to effectively meet the needs of the medically underserved, both domestically and internationally,” Dr. Rusch said. OGB has, in recent years, developed a program to cultivate sustainable partnerships to promote surgical education and quality in low-resource countries. “This past year, in collaboration with more than a dozen U.S. academic institutions with established expertise in global surgery, OGB inaugurated the first such partnership in sub-Saharan Africa, specifically at Hawassa University in Ethiopia,” she noted.
“None of the ACS activities that I have just described would be possible without a veritable army of enthusiastic, talented, and very hard-working surgeon volunteers. They come from all surgical specialties and from all corners of the ACS membership. Their efforts benefit all of our patients. They exemplify the joys of learning, collaborating, and giving back,” Dr. Rusch said. “These may be the best of times and the worst of times, but on balance, I think that, together, we can make them the best of times.”