Other surgical organizations
The birth of the ACS changed surgical practice by creating a professional organization that provided leadership
and instruction for all providers of surgical patient
care, from medical students to established surgeons.
At present, membership in the College is open to medical students, residents, and surgeons in all stages of
their careers, with each phase of training serving as a
stepping stone toward becoming a Fellow of the ACS.
While the ACS has grown to be the largest surgical
organization in the world, it was not the first national
surgical organization in the U.S. The American Surgical
Association (ASA) was founded by Samuel Gross, MD, in
1880, making it the nation’s oldest surgical association.
Dr. Gross invited distinguished surgical practitioners,
writers, and teachers to attend a meeting at the College
of Physicians and Surgeons of New York City on May 31,
1880.8, 9 This organization would first be known as the
American Surgical Society, but under Dr. Gross’ leadership the name was changed to the ASA in 1885 when a
group of approximately 50 surgeons assembled in New
York to adopt a constitution.
8, 9 At the time, ASA fellowship requirements included being at least 30 years old, a
graduate of a “respectable” medical school, and having a
reputation as a practitioner, author, teacher, or original
observer in surgery.
More recently, the Association for Academic Surgery
(AAS) was established during a 1967 meeting in Lexington,
10 George D. Zuidema, MD, FACS, was both a founding
member and the first president of the AAS.
10 Membership was initially open to any surgeon with an academic
affiliation, and membership grew exponentially from 377
members at its founding to 1,400 members in 1976, and
then to more than 2,700 members in the early 1990s—an
800 percent increase in less than 30 years.
10 The stature of
the AAS also has increased from 37 papers presented in
1976 to more than 140 in 1991, and to nearly 200 by 2001.10
Continued commitment to QI
With the growth of multiple organizations over time,
surgical quality and excellence have remained priorities
for the ACS. Surgical quality improvement (QI) efforts
began as early as 1913 when the Boston, MA, surgeon
Ernest Amory Codman, MD, FACS, pioneered the “end
result idea” in medicine, which called for patients’ out-
comes to be systematically recorded to determine the
success of treatment practices and to prevent future
QI is still a high priority for both leaders and members of the College. The centerpiece of the College’s
QI initiatives is the ACS National Surgical Quality
Improvement Program (ACS NSQIP®). ACS NSQIP
originated in the U. S. Department of Veterans Affairs
(VA), and VA NSQIP was developed as a result of the
scrutiny of VA hospitals in the mid-1980s in response
to poor surgical care discovered through the National
VA Surgical Risk Study.
2, 12,14 Subsequent to VA NSQIP’s
implemention in 1991, 30-day postoperative mortality
and morbidity dropped 43 and 47 percent, respectively.
In 1999, private sector hospitals started to adopt
and implement NSQIP, and in 2004, the ACS launched
ACS NSQIP at 14 hospitals.
12 Today, under ACS NSQIP
Director Clifford Y. Ko, MD, MS, MSHS, FACS, approximately 770 hospitals use the program to improve
surgical care quality.
12 One of the unique qualities
of the ACS NSQIP is that the data collected are risk-adjusted and drawn from medical charts, and not from
billing files, which are generally inadequate in measuring quality of care.14 Not only does ACS NSQIP
provide guidelines for improvement, it also gives hospitals the necessary tools for improvement initiatives
by providing the means and support to start new study
projects.14 Dr. Ko stresses the importance of collecting
quality data in order to make improvements with the
understanding that each hospital has unique needs.14
With health care costs in the U.S. climbing to an
alarming $2.9 trillion in 2013, health care policymakers
have sought to lower spending through higher quality
and more efficient patient care. A cornerstone of this
effort has been the pay-for-performance (P4P) model.
The idea behind P4P—a concept introduced in California in 2001 after the Institute of Medicine (now
the National Academy of Medicine) report To Err Is
Human documented serious health care deficiencies—is
to reward health care providers who meet or exceed