The Board of Regents of the American College of Surgeons (ACS) met June 9-10, 1995 in Chicago, Illinois. This report summarizes the highlights of that meeting.
ACS member Greg Ganske, MD, a plastic surgeon who also is a newly-elected Congressman from Iowa, made a special presentation to the Board. Congressman Ganske discussed his own involvement in the arena of health care policy and health care reform. He currently sits on both the House Energy and Commerce Committee and the Health and Environment Subcommittee.
Education
The College’s Committee on Emerging Surgical Technology in Education has produced a statement on new surgical technology, which was adopted by the Board of Regents. It is particularly pertinent to issues that have been raised with regard to endovascular surgery and should benefit neurosurgeons confronting this and other new technologies.
The Graduate Medical Education Committee of the College has been working on a study of prerequisites to entering a career in surgery, both at the medical school and PGY1 levels. It also continues to annually sponsor the “Surgeons as Educators” workshop, which is quite successful, and will develop an expanded faculty so that more workshops can be offered at multiple sites during the next few years.
The College has supported all payer aid for graduate medical education, as well as full certification and credentialing which would imply seven years of support for neurosurgery. It also has requested relief from the Federal Trade Commission’s requirements when plans for altering the surgical workforce are being considered.
The Surgical Research and Education Committee has been advocating leading an effort with the National Institutes of Health to obtain additional funding for surgical research.
Young Investigators
The 1996 Young Surgical Investigators Conference was a great success and is now planned to be an annual event. The Young Surgeons, likewise are quite active and held the 24th Annual Meeting of Young Surgeon Representatives in Chicago during April. They are developing a panel discussion on initiatives for cost effectiveness in surgery and are working hard to involve more young surgeons in efforts of common interest.
The Surgical Forum, which takes place at each ACS Clinical Congress, is an excellent opportunity for Young Investigators to present peer reviewed work and the next Forum will have a new session devoted to Outcomes of Clinical Research.
The Advisory Council for Surgery convened a meeting of a “New Group of 100,” which consists of 100 young surgeons primarily from the practice area and from smaller towns. The surgeons felt that the most important issues facing them were maintaining a high standard of care and freedom of choice for patients. Concerns over the impact of managed care were the overriding issues discussed by this group.
A handbook is in preparation for young surgeons entering practice and a superb educational video on substance abuse among surgeons has been produced and is available.
Professional Liability
It was reported that product liability reform legislation is likely to be passed during this session of Congress but professional liability reform has been excised out and probably will not pass this year. The activities of the National Practitioner Data Bank are being monitored carefully.
A revision of the College’s Professional Liability/Risk Management Manual for Surgeons is being prepared and should be ready for distribution in 1996.
Reimbursement
In the area of physician reimbursement it was noted that the practice expense study is underway and should provide valuable information with regard to both general and subspecialty surgical practice. It was noted that Medicare regulations will probably no longer include a separate volume performance standard for surgery which will, of course, mean that the fee structure for surgical procedures will in effect be reduced and be treated the same as reimbursement for”cognitive” services.
It is noteworthy that the American Medical Association has supported the reduction to one MVPS, ignoring the fact that responsible performance by the surgical community has resulted in an economic benefit under our separate surgical MVPS. It is hoped that, if we do move to a single MVPS, it will be done in a “phase out” fashion rather than immediately.
Surgical Workforce
With regard to workforce, the College presented figures that showed Kaiser uses 101 physicians per 100,000 population. The HMO average is 83 per 100,000 population and, in the uncontrolled marketplace, the average is 180 physicians per 100,000 in population. A recent poll of surgeons showed that 50% or more of practicing surgeons have suffered a 10% or more decrease in their reimbursement.
The American College of Surgeons maintains its participation in the various Residency Review Committees dealing with surgery and its subspecialties and is doing a good job with the monitoring of these activities. There is a Regents’ Committee on Informatics dealing with computerized methods of giving Fellows more in the way of communication and there will be an informatics program presented at the next ACS Clinical Congress.
We remain confident that the American College of Surgeons is providing truly effective leadership for surgery and neurosurgery.