1. ACS Board of Governors Annual Meeting ACS Clinical Congress 2012

2. ACS - In Good Hands 2011-2012 Year in Review David Hoyt MD Executive Director A. Brent Eastman MD ACS President-Elect J. David Richardson MD Chair, Board of Regents Patricia Numann MD ACS President

3. A. Brent Eastman, MD, FACS, installed as 93rd ACS President

4. Installation of Officers Chair, Board of Regents Julie Fleischlag, MD, FACS President Elect Carlos Pelligrini, MD FACS

5. ACS Centennial Celebration

6. 100 YR Centennial

7. American College of Surgeons Mission Statement: “The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.”

8. ACS Board of Governors 270 Governors – 149 Governors-at-Large 1 or more for each state and Canadian province, in general proportion to the number of ACS Fellows residing therein – 81 Specialty Governors Representing Surgical associations and Societies – 40 International Governors Representing International Countries and Chapters 1 for at least 15 Fellows from the country requesting

9. American College of Surgeons Board of Governors GOALS: 2012 1. Increased communication with B/G 2. Standardize and increase diversity for B/G nomination and selection process 3. Strategic planning – B/G Committee structure (Committee on Comittees) 4. 10-yr Review of Annual B/G Survey 5. National and International Chapter activities IMPROVE COMMUNICATION INCREASE PRODUCTIVITY

10. Strategic Planning – B/G Meeting Wednesday, August 8/2012 Attendees – David Hoyt MD, Executive Director – Patricia Turner MD, Director, Division of Member Services – ACS B/G Executive Committee – Pat Sprecksel, Senior Administrator Review of B/G Goals and Direction – Establish a clear identity for B/G – Action-oriented; advocacy for Fellows – Alignment/interaction with other ACS Committees, review what is needed – Evaluate for redundancy, synergy – Re-design/Restructure B/G Committees

11. Board of Governors Participation and involvement from the Governors varies greatly which severely hampers their effectiveness in successfully fulfilling their role The College needs to develop better mechanisms to understand their interests and determine an appropriate opportunity for them to be actively involved within the College Reassess the composition (including # of) Governors to better match the constituency Incorporate a Governor review and feedback process to drive more accountability Assessment ResultRecommendation Strategy Governors need more interaction with one another and need a clearer chartering of work from the Regents Create a formal time for the BOG to present at Regent Meetings Review Governor priorities to ensure proper alignment with the College mission  Examples of poor alignment (Reimbursement, Tort reform) Incorporate newer, easier ways for the Governors to interact with each other and other parts of the College including:  Smaller, more local retreats  Webinars, Teleconferences  Involvement in BOR committees  Regent involvement in BOG committees Process Technology Process

12. ACS Board of Governors Duties The Governors shall act as a liaison between the Board of Regents and the Fellows, and as a clearinghouse for the Regents on general assigned subjects and on local problems.

13. ACS Board of Governors Duties Provide bi-directional communication between B/G and their constituents Participation in B/G Committees Attend B/G Meetings (Annual Clinical Congress) Complete Annual Survey Participate in Clinical Congress Convocation Attend Annual Business Meeting of Members Attend Chapter Meetings Attend Local Committee on Applicants Meetings

16. B/G Events for 2012 ACS Clinical Congress Saturday, September 29 New Governors’ Meeting 3:00–3:30 p.m. B/G Committee Meetings 3:30-6:00 p.m. Sunday, September 30 B/G Annual Meeting 7:00 a.m.-1:00 p.m. B/G Luncheon & Open Forum 1:00-2:30 p.m. Convocation 5:00-8:00 p.m. Tuesday, October 2 B/G Reception & Dinner 7:00-11:00 p.m. Wednesday, October 3 B/G Adjourned Meeting 7:00-8:30 a.m. Annual Business Meeting of Members 4:15-5:15 p.m.

17. Committee Reports Fiscal Affairs Socioeconomic RAS Young Fellows PAC Surgical Practices State of Graduate Medical Educatio Executive Director President's Report and more....

18. Fiscal Affairs Committee 350M assets 105M liabilities 800K operating deficit for 2011, on income of 6M and expenses of 7M

19. Fiscal Affairs Committee dues increase of up to 3% per year approved by BOG in 2011 to avoid erratic dues increases 2003 - 2010 $440 No dues increases 2011 $520 (25%) 2012 $560 (7.6%) 2013 $560

20. Previous ACS Dues Changes Fellows DuesU.S. 1966 - $10 increase$60 1970 - $10-25 increase annual 1970-91$70 1991 - $10 increase$365 1992 - $10 increase$375 No ACS Dues Increase for 11 years 2003 - $65 increase$440 No ACS Dues Increase for 8 years 2010$440 2011 - $80 increase$520 2012 - $40 increase$560

21. Recent ACS Dues Changes Fellows DuesU.S.CanadaInternational 2010$440$335$155 2011 - $80 increase U.S.$520$375$175 2012 - $40 increase U.S.$560$400$190 Senior (Age 65-70) DuesU.S.CanadaInternational 2010$ --- 2011$260$188$88 2012$280$200$95

22. Approved Dues Policy Policy was approved by the Board of Regents & Board of Governors October 2011 Annual dues increases not to exceed 3% per year Dues increase can be suspended at Board of Regent discretion for any given year NO DUES INCREASE FOR 2013

23. 2012 ANNUAL REPORT RAS Chair Heena P. Santry, MD MS SEPT 29-30 2012

24.  What do resident and associate members want from the College? Overview

25. 2011 Survey Results  1225 resident respondents (~10% response rate)  82% in GS fields  50 PD respondent (~25% response rate)  95% FACS

26. Only 19% of residents actively involved in the College

27. Why join the ACS?  Just because  70% happened as interns (RES)  46% programs pays dues (RES)  56% programs mandate membership (PD)  What the college stands for  Only 50% had heard about the relevance of the College (RES)  Only 9% programs require meaningful participation at local, regional, or national level (PD)

28. Benefits (Resident Perspective)  Free JACS subscription (92%)  Discounted CC registration(84%)  Free Bulletin subscription (73%)  Free Surgery News subscription (69%)  Job Bank (66%)  Discounts for SRGS (62%) 28  Online videos of operative techniques (93%)  Participation in national advocacy (70%)  Access to recorded CC sessions (70%)  Practice questions for ABS/ABSITE (94%)  Online board preparation courses (93%)  Residency/Fellowshi p database (86%)

29. Graduate Medical Education

30. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents 5345 Categorical general surgery resident surveyed 2008 4402 (82.4%) Response 248 / 249 Surgery residency programs 1185 (27.5%) Not comfortable with independent performance of procedures 2681 (63.8%) Must complete specialty training to be competitive Yeo, H., et al. JAMA Vol.302 No. 12, Sept. 23/30, 2009

31. Annual Survey- B/G Mandatory Survey of the Board of Governors – As stated in the ACS Bylaws, Article III, Section 4., Governors "shall render reports on their local activities and on the College situation in their areas." Annual B/G Survey – Now includes additional questions relevant to a single topic – Surgical resident education this year 10-year review of BOG Survey

32. 2012 B/G Survey Analysis Percent 1-5 in degree of importance 1= very unimportant 5=very important

33. B/G Survey Results (% > 6) On 1-10 Graduate Medical Education

34. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents 5345 Categorical general surgery resident surveyed 2008 4402 (82.4%) Response 248 / 249 Surgery residency programs 1185 (27.5%) Not comfortable with independent performance of procedures 2681 (63.8%) Must complete specialty training to be competitive Yeo, H., et al. JAMA Vol.302 No. 12, Sept. 23/30, 2009

35. Program Director Quotes Amount of “work” (paper) has increased exponentially in last 10 years Most of that “work” has absolutely no bearing on improved surgical graduate education and certainly not on patient care. The current required structure of residency education promotes a change in the way we practice …….. largely disregards the patient. Created an environment that effectively says to the resident “your personal well being is more important than the patient you treat” Program Director Quotes Amount of “work” (paper) has increased exponentially in last 10 years Most of that “work” has absolutely no bearing on improved surgical graduate education and certainly not on patient care. The current required structure of residency education promotes a change in the way we practice …….. largely disregards the patient. Created an environment that effectively says to the resident “your personal well being is more important than the patient you treat” Confidence in graduating residents has diminished

36. Program Director Quotes Amount of “work” (paper) has increased exponentially in last 10 years Most of that “work” has absolutely no bearing on improved surgical graduate education and certainly not on patient care. The current required structure of residency education promotes a change in the way we practice …….. largely disregards the patient. Created an environment that effectively says to the resident “your personal well being is more important than the patient you treat” Confidence in graduating residents has diminished

37. Surgical Residency Training: The Need for Reform Frank R. Lewis, M.D. Executive Director American Board of Surgery September 30, 2012 Board of Governors American College of Surgeons Chicago

38. Potential Solutions Increase the length of resident training, either by extending the residency to 6 years or combining residency with mandatory specialty fellowship training. 80% + of residents are already completing post- residency fellowships, so the impact of adding the other 20% would be significant but manageable. A combined program of residency and fellowship offers significant advantages, with Board eligibility still achieved at 5 years. Conditional independence, limited autonomy, and ability to bill to generate salary support would all be present in fellowship but not residency. The specialty fellowships which are absent are in broad general surgery and acute care surgery.

39. Executive DIrector, David B. Hoyt, MD, FACS SGR, Fiscal Cliffs, and ACO's most significant time of change since the Flexner report forever changed medical education in this country leading by emphasizing quality, surgical outcomes, patient care (NSQIP, TQiP) advocacy on behalf of surgeons and patients(ACS-PAC, F Street) ACS sponsored effort at rewriting the rule book on surgical reimbursement

40. Robert R. Bahnson, MD, FACS SurgeonsPAC Chair

41. Where do we stand? We can do better… Despite having the largest membership we are 7 th largest physician PAC, trailing Orthopaedic Surgeons, Anesthesiologists, Radiologists, Emergency Physicians, Ophthalmologists and Pathologists Still at 4% market share, compared to above groups at 33%-20%!

42. SurgeonsPAC Fundraising: Overview

44. The good news is, we have enough money to make a difference. The bad news is, it's still out there in your pockets.