Since the founding of the American College of Surgeons (ACS) in 1913, the organization’s Presidents have delivered an address describing their professional experiences and outlining their vision for the future. Each ACS Past-President offers sage advice in these addresses, often in the form of pointed aphorisms, on a wide spectrum of topics with the goal of galvanizing new Initiates and defining the goals and notable achievements of the College.
History of ACS Presidential Addresses
The first ACS President to address the College was J.M.T. Finney, MD, FACS, in 1913. In his address, Dr. Finney asserted that “The American College of Surgeons…stands only for the good of humanity and the uplift of professional standards of morality and education. If it does not fulfill its special mission…it is your own fault.”1,2
George Crile, MD, FACS, delivered the second address as incoming College President in 1916. After Dr. Crile’s address, no Presidential Addresses were delivered until 1919, when William J. Mayo, MD, FACS, became President of the combined ACS and Clinical Congress.
According to the ACS Archives, the address of each incoming College President was delivered at the Convocation at the end of Clinical Congress week until 1936, at which time it was discontinued. Thereafter, each President made one address upon retiring from office, until 1953. That year, the retiring President, Harold Foss, MD, FACS, delivered his Presidential Address on Monday evening, and Fred Rankin, MD, FACS, gave an address as incoming President on Friday evening. Since then, each College President has made a single address at the Convocation.2
“They weren’t always called Presidential Addresses—they were called ‘Address to the Fellowship,’ for example,” said David L. Nahrwold, MD, FACS, retired chair of surgery at Northwestern University, Chicago, IL, and coauthor of the book chronicling the history of the ACS titled A Century of Surgeons and Surgery: The American College of Surgeons—1913–2012.3 “And in the early days, they were given by a variety of people, and they focused on what the College was doing and what the College was trying to accomplish. In other words, these addresses were focused on the idea of excellence as a surgeon to try to explain to people whom this College is composed of and to differentiate surgeons from doctors who did surgery.”
“Howard C. Naffziger, MD, FACS, in one of the earlier addresses from the 1940s, titled Metamorphosis of the Surgeon, refers to it as a ‘commencement address,’” added Peter J. Kernahan, MD, PhD, FACS, a surgeon, medical historian, and coauthor of A Century of Surgeons and Surgery: The American College of Surgeons—1913–2012. “I think, similar to a commencement speech, these addresses are a way of passing on the ideals and the goals of the organization to young surgeons just entering the College.” In fact, the origin of the commencement speech harkens back to medieval times when students entered universities as apprentices and left ready to “commence” their professions.4
“From the historian’s point of view, the ACS Presidential Addresses really show us what issues people considered important at the time,” said Dr. Kernahan. “Early on, two of the biggest challenges were the state of hospitals and the hospital standardization program, and the attempt to distinguish the qualified surgeon from the unqualified surgeon at a time when the public had absolutely no way of making that distinction.”
In fact, until the late 19th century, standards of care, quality, and residency training were relatively new concepts for the surgical profession, and most surgeons operating at that time were self-taught and unsupervised.5 The creation and development of the College resulted in a professional organization that offered leadership and standards for education and practice for all providers of surgical care.
In Dr. Finney’s first Presidential Address, he describes the rationale for the formation of the College, according to Drs. Nahrwold and Kernahan. “He’s defending the College against some of the criticisms that were leveled against it at the time,” Dr. Kernahan said. “And that’s picked up again in Crile’s address and during Mayo’s address. As we go on, and it starts even by the late 1930s, you start to see people talking about some broader issues in these addresses. And certainly, by the time we get to the last 50 years, increasingly issues of government involvement in health care are a focus.”
ACS Presidential Addresses: 1996–2020
In reviewing the ACS Presidential Addresses from the last 25 years (1996–2020), four overarching themes emerged:
- Leadership
- Surgeon wellness
- Diversity and inclusion
- Patient care and quality care
This article shares a selection of notable excerpts from ACS Presidential Addresses that are tethered to these identified categories with the goal of showcasing the enduring and evolving wisdom and legacy of College leadership (see below).
In addition to the four themes of leadership, surgeon wellness, diversity and inclusion, and patient care and quality care, Dr. Kernahan said he would add “professionalism” and “concerns related to surgical specialization and the future of general surgery.”
“In the 1950s or so, the concern among specialists was that the College just represented general surgery or general surgeons. By the 1980s, there is a sense that the general surgeons aren’t really represented by the College. And so, I think that’s one other theme that is a subtext that runs throughout some of these addresses and that is historically a challenge for the ACS, to broadly represent multiple surgical specialties,” Dr. Kernahan said.
“I think leadership has been a constant [theme] in these addresses, especially as it relates to governmental affairs,” added Dr. Nahrwold. “The other constants, in my opinion, are patient care and quality of care—and, ultimately, these are the most important. These are why surgeons exist; it is why the College exists, really. It would be disappointing if a Presidential Address weren’t focused on that. I think the greatest ACS Presidential Address of all time was delivered by LaSalle D. Leffall, Jr., MD, FACS, in 1995.”
A cornerstone of Dr. Leffall’s address, Reaffirmation of Fealty—To Serve All, is patient care. In his oration, Dr. Leffall said, “There is no closer, more reverent, or more honored bond than the one that exists between surgeons and their patients.”6 Later in the speech, he asserts, “We must never forget that the object of our affection is the surgical patient.”6 “That is not something most surgeons would say, but Dr. Leffall really meant that. And, on reflection, I believe most surgeons would agree with Dr. Leffall’s statement,” Dr. Nahrwold said.
Dr. Kernahan also referenced Dr. Leffall’s 1995 speech as exemplary, as well as George F. Sheldon’s, MD, FACS, 1998 address, Professionalism, Managed Care, and the Human Rights Movement; and LaMar S. McGinnis, Jr.’s, MD, FACS, 2009 address, Professionalism in the 21st Century.
“Another interesting one is C. Jeff Miller’s, MD, FACS, 1930 address, The Doctors of Fiction—it’s the only one that engaged in literary criticism,” said Dr. Kernahan. “It’s his review of [Sinclair Lewis’s] Arrowsmith and other books and novels about doctors, which were very popular at the time.”
Presidential orations in the future
ACS Presidential Addresses traditionally outline the challenges faced by the College and illustrate the aspirations for the organization, all through the lens and perspective of the leader delivering the speech. With this in mind, how will the content and format of future ACS Presidential Addresses evolve in the future? In the digital age, does the formal, spoken word continue to inspire and inform members and other interested stakeholders?
“It’s always hard to try to make predictions,” said Dr. Kernahan. “But I think one contrast we have this year and last year, it’s that we’re able to get the address in an online format. I don’t know—maybe it’ll all be virtual in the future. I certainly would think some aspects of the Clinical Congress might well be running in parallel to in-person meetings, which means things like Presidential Addresses would be more accessible to a wider audience in the virtual environment.”
“The memory of these addresses is very short, so, I think that’s one context you have to deal with in these Presidential Addresses. That being said, when they are written out and when they are distributed after they’re given orally, I think they have more meaning to some Fellows,” said Dr. Nahrwold, noting that in the early days of the College, Presidential Addresses were published in Surgery, Gynecology and Obstetrics (now the Journal of the American College of Surgeons [JACS]), and later, in the ACS Bulletin.7 “Usually, these addresses are extremely well delivered, but because the thoughts are quite deep, one needs to be able to mull over these addresses in order to get their full meaning. In a perfect world, it might be best to tell people who are going to give Presidential Addresses that the most important thing that’s going to happen here is that what you say is going to be published. So, write it as if it was going to be published, not necessarily delivered before a group of people.”
Although the content and delivery platform for ACS presidential orations will continue to adapt with current-day challenges and opportunities, these presentations will undoubtedly continue to highlight the fundamental goal of the College—to serve all with skill and fidelity.
“Presidential Addresses will likely always do a couple of things,” Dr. Kernahan said. “One is they’re there to encourage engagement with the College. It’s also used by the speaker to illustrate how much change there has been over their lifetime and to let young surgeons know that similar changes can be expected over their own professional careers. The other thing is thanking mentors, which in surgery has a long tradition. We still pass on the craft and that old idea of apprenticeship. I think all surgeons remember those who taught them, even if they don’t give a Presidential Address.”
Acknowledgment
The author would like to thank Meghan Kennedy, ACS Archivist, Division of Member Services, Chicago, IL, for her perspectives on College history specifically regarding past Presidential Addresses and for her and Michael Beesley’s, ACS Assistant Archivist, help in researching and locating ACS past Presidential Addresses.
Following is a selection of noteworthy excerpts and quotes from ACS Presidential Addresses spanning the last 25 years. As previously stated, these excerpts are organized into four categories: leadership, surgeon wellness, diversity/inclusion, and patient care/quality care.
Each of these presidential addresses is featured once within one of the four categories. Reviewing and selecting these excerpts is a purely subjective exercise, as these orations cover a wide spectrum of relevant and informative topics. The purpose of these excerpts is to provide the reader with a glimpse into the perspectives of ACS leaders from the recent past.
For further examination, these and the entire list of ACS presidential orations are available here via the ACS Archives.
Leadership
1997 Seymour I. Schwartz, MD, FACS: Credo, Conduct, and Credibility
The American College of Surgeons floats and sails on a ship that is more akin, allegorically, to that of the late Jacques Yves Cousteau’s Calypso, plying the seas in order to expand knowledge and preserve the meaningful environment: an altruistic goal, rather than that of a tanker carrying a commodity to enrich the owner. The panoply of the College’s meaningful contributions to society transcends all surgical specialties. The American College of Surgeons is, in essence, the cement substance that brings and binds all surgical disciplines and proceeds from that commonality. As such, it is unique in its capability to articulate the position of Surgery, with a capital S, in the governmental halls of Advice and Consent.
2000 Harvey W. Bender, Jr., MD, FACS: Omnibus per artem fedemaque prodesse: To Serve All with Skill and Fidelity
In our daily practice, as we attend to the needs of one patient at a time, we see the impact of our work on individual lives, and this is a gratifying experience. By becoming active in the American College of Surgeons, each of you has an opportunity to exert your influence on countless numbers of patients and to have input into the development of a health care system that will flourish in this new century. I do not know what the agenda will be for the College in the future, but I do know that you must help to set it. I am confident that you will give that agenda your attention and will set priorities consistent with the mission of the College.
2004 Edward R. Laws, MD, FACS: Harvey Cushing and the Unity of Surgery
And so, in an historical review of one individual we can find many aspects of surgery as we now know it, and note the many roles that we as surgeons may play: the surgeon as humanist; the surgeon as student and lifelong learner; the surgeon as innovator; the surgeon as educator; the surgeon as scientist; the surgeon as philosopher; the surgeon as role model. These facets of a brilliant surgeon reflect the collegial aspects of his evolution as a surgical leader and remain of vital importance to us today.
2007 Gerald B. Healy, MD, FACS: Competence, Safety, Quality: The Path of the 21st Century
Leaders determine the ultimate effectiveness of the organization as their character and skills determine the way in which problems are solved and tasks are accomplished. Never forget that Martin Luther King, Jr., in his profound declaration to the world, said, ‘I have a dream.’ He did not say, ‘I have a very good plan.’ Leaders provide passion and a strong sense of purpose for change. Leaders communicate a vision to their organization and endeavor to build excellence rather than command it.
2009 LaMar S. McGinnis, Jr., MD, FACS: Professionalism in the 21st Century
This century will be a century of change like no other. Successful paradigms of the past and of the present will rapidly fade. Medical education, training, and delivery of health care will radically change, perhaps change akin to that which occurred in the first two decades of the last century.
2013 Carlos A. Pellegrini, MD, FACS: The Surgeon of the Future: Anchoring Innovation and Science with Moral Values
Delivery of this type of care cannot be done by individuals acting alone; it requires the development of teams, high-performance teams. These teams require leadership. Not the authoritarian leadership of the past, but the kind of leadership that fosters exceptional communication, mutual respect and support, and the development of the best and most straightforward ways to achieve the goals of the mission: improving the health of our patients. Leadership is an area that needs our direct involvement, and the smart surgeon of the future will devote a substantial portion of their time to the study of qualities of effective leaders, to the development of emotional intelligence, and to the improvement of so-called non-technical skills. Your College is deeply involved in these areas and has developed the infrastructure to support it. I encourage you to get involved, not only because it will help your future, but because it is the right thing to do for our patients and our society.
Surgeon Wellness
1999 James C. Thompson, MD, FACS: Gifts from Surgical Research: Contributions to Patients and Surgeons
Before you tell me how busy you are, please allow me to visit a discomforting idea on you…and that concept is: Time is infinitely elastic and expands so as to allow you to do the things you want to do. I know this to be true because no matter how busy I find myself, if a truly great opportunity were to arise (say, dinner with Warren Buffett, Ella Fitzgerald, and Walter Cronkite, or a ride on a space launch, for example), I’d simply elbow all commitments aside, and do it. What this actually means, is that when I tell you that I haven’t the time to accede to some request of yours, what I’m actually saying is that I’ve weighed that request on the scale of my priorities and have decided to do something else. Painful but true. I hope you find time to do research.
2011 Patricia J. Numann, MD, FACS: Stewardship of Our Profession
Part of the stewardship of our profession is our responsibility to one another. When we see our colleagues in need of help, whether it is with regard to acquiring new knowledge or skills or in dealing with personal or professional crises or disabilities, we should help them. Should we see colleagues who have cognitive or physical impairments that do not allow them to continue practice, we must encourage them to modify or change their practice or to step down. If individually we are unable to advise them or influence them, we must ask for assistance from our leaders. Stewardship of our profession does not allow us to look the other way. We all became physicians not only because of our interest in science but also because of our commitment to humanity. Each of us is a steward of our profession by the example we set in our personal and professional behavior. In this time of health care reform, we must be ever-more vigilant in protecting our patients and our profession.
2019 Valerie W. Rusch, MD, FACS: The Joys of Learning, Collaborating, and Giving Back
To paraphrase Charles Dickens, this is the best of times, but also the worst of times. Rapid changes in today’s health care environment are leaving some surgeons feeling overwhelmed and isolated. Recent studies report that burnout affects 30 to 50 percent of residents and practicing surgeons, with perhaps surgical residents and women being at greatest risk. While the factors responsible for this situation are not fully understood, increasing administrative and documentation demands, the loss of personal autonomy related to the corporatization of medicine, and long work hours and work-life imbalance are consistently cited as culprits. Added to this are national problems in health care delivery. While lower- and middle-income countries often struggle with a lack of resources and infrastructure, the U.S. has a highly resourced but also highly politicized and dysfunctional health care system with many disparities in the provision of care. It is easy to focus on the daily frustrations of our work environment while losing sight of the great opportunities to improve the care of our patients.
How can we best move forward under these challenging and often frustrating circumstances? As discussed in the August issue of the ACS Bulletin, collaboration with others and participation in efforts that address a common need or common good not only lead to more effective results, but also can be personally rewarding. For those of us who practice oncology, multidisciplinary collaboration is inherent in what we do every day. Increasingly, though, this is true of all surgical specialties. Today, such collaborations may reach across surgical specialties, reach across specialties outside of surgery, or reach across disciplines outside of medicine. As new ACS Fellows, many of you may look to various subspecialty societies as the primary source for education and a forum for scientific presentation in your area of interest.
