state and local government, and as advocates through professional organizations such as the ACS.
Within the College, surgeons have led the effort to formalize advocacy activities through the Division of Advocacy and
Health Policy (DAHP);
20 through ACS standing committees,
such as the Health Policy and Advocacy Group (HPAG), the
Health Policy Advisory Council (HPAC), and the Legislative Committee; and as surgeon champions for issues such
as surgical quality improvement, liability reform, rural care
access, and trauma system development.
21 ACS Past-President
Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), was instrumental in forming the ACSPA-SurgeonsPAC, an adjunct to the
policy arm of the ACS.
22 The SurgeonsPAC was established in
2002 and provides the infrastructure and support necessary
for advocacy and lobbying activities.
Under the leadership of surgeon-advocates, the ACS has
successfully promoted legislation that seeks to improve
patient safety and quality of care while addressing the concerns of the surgical profession. One of the most significant
accomplishments in recent years has been the repeal of the
sustainable grown rate and the passage of the Medicare
Access and CHIP (Children’s Health Insurance Program)
Reauthorization Act (MACRA) of 2015.23 This legislation
averted a more than 20 percent reduction in physician
reimbursement, while also writing into law several quality
The importance of physician advocacy is widely recognized by professional organizations within the U.S. The
American Medical Association’s Declaration of Professional
Responsibility states that physicians should “advocate for
social, economic, educational, and political changes that
ameliorate suffering and contribute to human well-being.”
Based on this statement, one proposed definition of physician
advocacy developed at the University of Colorado School
of Medicine, Denver, is “action by a physician to promote
those social, economic, educational, and political changes
that ameliorate the suffering and threats to human health
and well-being that he or she identifies through his or her
professional work and expertise.”
Advocacy can take many forms, and most surgeons act as
advocates on a daily basis when caring for patients. Each time
a surgeon develops a patient care pathway following surgery,
attends a meeting to discuss a quality improvement activity,
RAS-ACS SYMPOSIUM: REFRAMING SURGICAL LEADERSHIP
1. American College of Surgeons. Statement on
Principles Underlying Perioperative Responsibility.
Bull Am Coll Surg. 1996; 81( 9): 39. Available at: facs.org/
May 31, 2017.
2. Nurok M, Sadovnikoff N, Gewertz B. Contemporary
multidisciplinary care—who is the captain of the ship
and does it matter? JAMA Surg. 2016;151( 4):309-310.
3. Britt LD, Sachdeva AK, Healy GB, et al. Resident
duty hours in surgery for ensuring patient safety,
providing optimum resident education and training,
and promoting resident well-being: A response from
the American College of Surgeons to the Report of
the Institute of Medicine, “Resident Duty Hours:
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4. Health Affairs. The Landscape of Physician Practice.
Health Aff. (Millwood). 2016;35:3388-3389.
5. Moalem J, Alseidi A, Broghammer J, et al.
Young surgeons speak up: Stringent OR attire
restrictions decrease morale without improving
outcomes. Bull Am Coll of Surg. 2016; 101( 10): 10-19.
Available at: www.facsbulletin.com/acsbulletin/
october2016?pg=11#pg11. Accessed May 31, 2017.
6. Merriam-Webster. Definition of “leader.” Available
Accessed May 31, 2017.
7. Prentice WCH. Understanding leadership. Harvard
Business Review. January 2004. Available at: https://
Accessed July 11, 2017.
8. McConnell v. Williams. 361 Pa. 355, 357 (Pa. 1949)
(“Opinion by Mr. Justice Horace Stern”), March
25, 1949. Available at: https://casetext.com/case/
mcconnell-v-williams. Accessed May 31, 2017.
9. Evers BM. The evolving role of the surgeon-scientist. J Am Coll Surg. 2015;220( 4):387-395.
10. Halsted WS. The training of the surgeon. Johns
Hopkins Hosp Bull. 1904;15:267-275.
11. Pitt D, Aubin JM. Joseph Lister: Father of modern
surgery. Can J Surg. 2012; 55( 5):E8-E9.
12. Britt LD. The American College of Surgeons: A
legacy of leadership. J Am Coll Surg. 2011;212( 2):141-
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