Do what’s right for the patient. This proclama- tion is the bedrock of the American College of Surgeons (ACS). It is our lodestar and the cardinal principle of the original Oath of 1913 and of the
Fellowship Pledge that Initiates make today.
Our calling, our mission, our passion are education and quality. These two objectives have been the
watchwords of our College since the beginning. They
are today and will be tomorrow.
Development and great progress in American surgery have come from surgeons—not imposed from
without—who recognized the shortcomings of the
present and set out to correct them for the future.
In this address, I would like to tell you the story
of the College—the who, what, why, and how of the
• Who: Individual surgeons recognizing a pressing need
• What: Improved education to ensure quality.
• Why: Surgical education and training were characterized by a lack of standards.
•How would this be done?
An organization would eventually be formed that
would have as requirements for membership standards for surgical competence and character of the
applicants, affirmed by their peers. The organization
would advance the science of surgery and the competent practice of its art and eliminate the incompetent
and occasional operator—to do what’s right for the
Within 25 years of its founding, the College established standards for educating surgeons, standards
for hospitals, and standards for graduate training for
general surgery and the surgical specialties. These
accomplishments did not happen simultaneously
but sequentially. As one set of standards was set, it
became evident that another would be required—to
do what’s right for the patient.
Dr. Martin’s vision
Who was Franklin H. Martin, MD, FACS—and why
did he decide to take on these challenges?
To fully understand Dr. Martin’s vision, we must
examine the state of medical education in the late 19th
and early 20th century. It was deplorable. Abraham
Flexner issued a report in 1910 titled Medical Education
in the United States and Canada. 1 The Flexner Report, as
it is commonly referred to, noted 155 existing medical
schools and placed each of them in one of three divi-
sions. 1, 2 Group I included 22 schools that required two
or more years of college work for entrance; Group II
comprised 50 schools that demanded actual graduation
from a four-year high school or its “supposed equiva-
lent”; and Group III was composed of 83 schools that
asked “little or nothing more than the rudiments or
the recollection of a common school education.”
State Boards of Medical Examiners were no help.
A total of 82 different boards were operating in 49
states and territories; all required only a written exami-
nation. A graduate of a medical school who passed a
state board examination and received a medical license
could enter practice the same day—without any formal
postgraduate training or restrictions on scope of prac-
tice. Internship was not required for licensure until
1914.3 Those individuals who wanted to become a sur-
geon would apprentice themselves to an established
surgeon upon whose skill and knowledge their edu-
cation depended. Furthermore, it required that the
senior surgeon remain current. This relationship often
lasted years. No standards were in place for medical
education, for postgraduate training, or for hospitals.
Now a bit more about Franklin Martin and what
drove him. He was born in 1857 in Ixonia, WI. He
was raised and went to school in a rural setting and
he worked in various manual labor jobs as a teenager.
In his autobiography, Dr. Martin wrote that in 1876,
“on a blistering day in August” as he was working in
the fields, he saw the local doctor, nicely dressed, drive
by in his buggy. At that moment, he decided he would
“be a doctor.” 4
Dr. Martin found an apprenticeship; entered Chicago Medical College, IL, in 1877; graduated in March