The Advocacy and Issues Committee of the Res- ident and Associate Society of the American College of Surgeons (RAS-ACS) hosts an annual
Symposium at the ACS Clinical Congress, featuring a
debate on controversial topics in health care and surgical practice. This year’s symposium will focus on
“Reframing Surgical Leadership in 2017: Surgeon-Scientist or Surgeon-Advocate?” and will take place
3:00−5:00 pm Sunday, October 22, at the San Diego
Convention Center, CA.
The symposium will be moderated by ACS Governor David Spain, MD, FACS, and will feature two
speakers: Amalia Cochran, MD, FACS, Chair, ACS
Professional Association political action committee
(ACSPA-SurgeonsPAC); and Caprice Greenberg, MD,
MPH, FACS, past-president of the Association for
Academic Surgery (AAS). Both speakers will present
their views on leadership and help lead the session’s
discussion. They will be joined by t wo resident/fellow
winners of the RAS Symposium Essay Contest.
In advance of the upcoming RAS Symposium, this
article provides some historical perspective on this topic
and addresses the two models of surgical leadership as
they exist today.
Background on the issues
A changing regulatory environment has led to dimin-
ished individual surgeon autonomy in the operating
room (OR) and in patient care. Historically, the surgeon
was regarded as the “captain of the ship” inside and
outside the OR.
1 In 2017, the surgeon is one of many
members of multidisciplinary health care teams and
often has limited autonomy.
2 The emphasis today is
on quality, safety, and outcomes. As a result, every
aspect of surgical care is scrutinized—from our train-
ing models, to our patient care practices, to our OR
3-5 Although surgeons welcome changes that
improve patient outcomes, many of our colleagues are
troubled by the increasing regulatory and administra-
tive burdens that lead to further loss of autonomy. How
can surgeons preserve their role as leaders in patient
care? Some members of our community advocate for
increased surgeon involvement in health care policy
and politics, business, and regulation. Other surgeons
want to revive the traditional roles of service, educa-
tion, and innovative research.
These varying perspectives ultimately lead to
the question of what surgical leadership should look
like in the 21st century. Should we strengthen our
commitment to surgical education and research,
as surgeon-scientists, or should we strive for a seat
at the table of business and politics and engage our
communities as surgeon-advocates? What is the ideal
balance to strike in the health care landscape as it
appears in 2017?
Surgeons as leaders
The term “leader” traditionally has been applied to
anyone who heads a group.
6 Today, the definition of
leader and leadership have evolved to include management of people, skill sets associated with developing
social influence, creating a vision, and the ability to
7 The captain of the ship metaphor
originated in the legal environment to assign liability for patient outcomes to the decisions made by the
8 Although this legal standard has
lost favor in courts since the 1950s, the concept remains
popular as an expression of the idea that the surgeon is
a leader in all aspects of the care of the surgical patient.
The traditional model of the surgeon-leader—
developed in renowned surgical departments around
the world decades before the first use of captain of the
ship as a legal term—is defined by the provision of excellent care to patients while also conducting research to
find innovative answers to clinical questions.
9 In academic environments, this surgeon-leader model has
been a requirement for surgeons who hope to achieve
what has traditionally been regarded as the pinnacle
of surgical leadership—an appointment as chair of surgery. Resident trainees since the time of William S.
Halsted, MD, FACS, have internalized this model as the
ultimate example of surgical leadership.
10 However, the
increasing complexity of a health care system governed
by myriad regulations has underscored the importance