Leadership & Advocacy Summit Unites Surgeons, Inspires Change

In the heart of Washington, DC, the ACS Leadership & Advocacy Summit became the epicenter for the connection of more than 700 surgeons—in person and virtually—who were galvanized by a shared commitment to advancing leadership skills and driving impactful change within healthcare advocacy. 

This powerful event, held at The Westin Washington, DC Downtown Hotel, April 13–16, underscored the vital intersection of leadership and advocacy in shaping the future of surgical practice.

“The 2024 Leadership & Advocacy Summit was another example of the leadership strength in the ACS,” said Michael J. Sutherland, MD, MBA, FACS, Director of the ACS Division of Member Services. “We brought together a slate of amazing individuals who all share one common trait: they are all Fellows of the American College of Surgeons. These formidable surgeons shared insights and expertise from their personal journeys to help us all become better leaders.”

Also worth noting, this year, leadership presentations were interspersed with advocacy topics to help provide the important throughline between learning about leadership to taking action for the profession and surgical patients.

How Do You Control the Risk?

Just before the official start of the leadership portion of the summit, three special preconference seminars were offered, including “Controlling Risk: The Techniques of Operating Excellence,” presented by Jim Wetherbee, a retired US Navy officer and aviator, aerospace engineer, and astronaut. A veteran of six Space Shuttle missions, the only American astronaut to command five missions in space, and the only person to land the Space Shuttle five times, he holds more than 3 decades of experience in high-hazard operational environments.

Wetherbee shared with a sold-out audience his thoughts on effective leadership behaviors that influence and inspire people to make life-and-death decisions in dynamic, complex situations and safely conduct dangerous endeavors with “critical mission objectives.”

During his talk, Wetherbee delved into the differences between managing risk—which companies do—and controlling risk—which surgeons do. He explained that organizations often issue rules-based procedures that employees are required to follow. But as good as rules-based procedures are, they are specific, limited, and cannot prevent all accidents nor mitigate all risk.

“What the individual does—if they’re good—is augment the rules, policies, and procedures with a suite of principles-based techniques,” he said. “Largely, these techniques are mental attitudes—how you think when you’re operating, flying, or reaching a building if you’re on a SWAT team. These techniques are adaptive and unlimited, and they can help you prevent all accidents and maximize results.”

The techniques of operating excellence include:

• Developing and maintaining risk awareness
• Expecting failures
• Following procedures (and rules) thoughtfully
• Identifying trigger steps
• Being assertive (to authority) when necessary
• Balancing confidence with humility

Additional techniques are examined at length in Wetherbee’s book: Controlling Risk: Thirty Techniques for Operating Excellence.

Mitigating Moral Injury

The Leadership Summit officially kicked off on Sunday morning, with compelling messages from Sunil K. Geevarghese, MD, MSCI, FACS, from Vanderbilt University Medical Center in Nashville, Tennessee.

In the session, “Moving Forward after Moral Injury: A Leader’s Perspective,” Dr. Geevarghese explored the dynamics of moral injury that surgeons may experience as a result of major surgical complications and the potential progression to second victim syndrome and burnout. He stressed that moral injury, second victim syndrome, and burnout are not “synonyms,” adding that moral injury happens much earlier.

“Moral injury is going to happen as we operate and care for patients. But second victim syndrome and burnout don’t have to,” Dr. Geevarghese said.

The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations,” according to Dr. Geevarghese. In the context of healthcare, moral injury is being unable to provide high-quality care and healing.

Sustainability in Healthcare

In the session, “Sustainability in Healthcare: Where We Are and Where We Want to Be,” Robin Blackstone, MD, FACS, from Blackstone Health in New York, New York, acknowledged that sustainability awareness is growing in healthcare with “major players” moving into the space.

Dr. Blackstone made mention of the Science and Technology for Sustainability Program from the National Academy of Sciences, stating that globally, 5% of the overall greenhouse gas emissions are from healthcare. In sophisticated, higher-income countries like the US, 8% to 10% of the overall emissions are from healthcare, of which 80% come from the OR.

“We are surgeons. We intervene and get involved. We solve problems, and this is a problem to solve. There is no bigger sustainability space where a difference can be made than in surgery,” she said.

Surgeons as CEO

A distinguished group of surgeon leaders shared important life lessons and valuable insights from their personal journeys to the C-suite: Selwyn M. Vickers, MD, FACS, from Memorial Sloan Kettering Cancer Center in New York, New York; Robert S. D. Higgins, MD, MSHA, FACS, from RUSH University in Chicago, Illinois; Julie A. Freischlag, MD, DFSVS, FACS, from Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina; Glenn D. Steele Jr., MD, PhD, FACS, formerly from Geisinger Health System in Washington, DC; and Bert W. O’Malley, MD, FACS, from the University of Maryland Medical Center in Baltimore.

The panel, “Surgeons as CEO: Career Paths to the Corner Office,” was moderated by Timothy J. Babineau, MD, MBA, FACS, from The Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Dr. Freischlag shared that her plan was to be “a really good vascular surgeon.” She was only the sixth woman vascular surgeon certified in the US, the only woman division chief in the country when she was leading vascular surgery at the University of California, Los Angeles, and only the fourth woman to be chair of surgery at Johns Hopkins Medicine in Baltimore, Maryland. 

“I quickly learned that you can’t change the world unless you’re in charge,” she said.

Dr. Vickers continued the conversation by describing the unique qualities that surgeons bring to the CEO role, such as building and working within teams and maintaining a commitment to rigorous process and accountability.

In addition, surgeons regularly face difficult problems and are often forced to make decisions with incomplete information, which helps prepare them for a CEO role. “We’ve had to learn nuance and perspective on making hard decisions when you don’t have all the data,” he said.

Dr. Steele added that surgeons are grounded in patient care. “Those of us who have been cutters in various specialties—no matter how complex our jobs are and how big our organizations are—are always somehow rooted in how our decisions are going to affect patient care, and that allows us to have credible relationships with the people who are actually doing the work,” he said.

The ability and willingness to take risks is another quality that surgeons bring to the senior executive offices. Dr. O’Malley explained that surgeons are reputable risk-takers. “We put a knife to patients, and every patient is a life-or-death risk, no matter what you’re doing. As a leader and CEO, taking risks is a big part of what you have to do if you want to change the culture or build the future.”

It can be lonely at the top, though, Dr. Higgins shared. He explained that a coach (he has two of them) can help examine and enhance leadership skills, identify short- and long-term goals, improve communication, foster strategic thinking, and perhaps most importantly, provide psychological safety. 

“A coach will give you the feedback you need to be better as a leader. I recommend that anyone who I hire at the senior management level have a coach,” he said.

A particularly poignant note—which garnered energetic nods and audible agreement from the other panelists—was shared by Dr. Vickers as he described the transition from leading a surgical department to becoming a CEO.

“When you’re head of a surgical department, it’s like a lion leading a pride of lions. Everybody knows your language. They’re close enough to touch you. They see you in the OR. They see you in the hallways. You share the same pedagogy and pedigree. But when you move to the next level like a dean or CEO, you’re a lion leading a zoo. It’s a totally different animal. Some of the species are predatory; some are nocturnal; all speak different languages. You really have to learn their world, and you have to be thoughtful.”

Executive Director’s Update

ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS, provided a comprehensive overview of the College’s performance, key achievements, current initiatives, and future plans.

“The ACS is a community of surgeons who have an incredibly diverse set of skills and expertise. The camaraderie among surgeons is real,” she said. “All of us are integral to the success of the healthcare system, and I hope you leave this meeting thinking about what you can do to exhibit your leadership in a way that is transformative for your institution, for your patients.”

Dr. Turner outlined the various opportunities for leadership within the ACS, including 14 advisory councils, the Board of Regents, and the Board of Governors. She encouraged member involvement in ACS committees from all surgical specialties and career stages and made special mention of the Resident and Associate Society and the Young Fellows Association, emphasizing that while residents and young fellows are the future of the organization, they already are leaders.

Advocacy Summit

In preparation for in-person visits to Capitol Hill, attendees engaged in several panels and educational sessions to better understand the College’s legislative priorities.

Power of the Patient Story

In the panel, “How to Advance the ACS Agenda in a Divided Congress,” moderator Rodney Whitlock, PhD, from McDermott+Consulting in Washington, DC, led a strong discussion on best practices when sitting down with members of Congress to discuss issues that impact surgery and patient care.

Don J. Selzer, MD, FACS, from Indiana University Health in Indianapolis, advised that “the long game of Congress” may require patience. “As surgeons, we all like to think about things according to how an operation works. We forget about the fact that many of us spent 8–12 years getting to the point of being able to do that. Congress is a little bit like the process of going from being an undergraduate to being a trained surgeon; it’s not like going from scrubbing in to performing a surgery.” 

He also explained that being passionate and enthusiastic about an issue is important, but even more so, is sharing personal stories. In other words, get the right story in front of the right person.

The “personal story” theme also was prevalent in another panel, “Working with Patient Advocacy Groups.” According to Leslie Krigstein, from Transcarent in Washington, DC, stories help humanize the request. “Having patient stories takes your ask to a different level.”

Terry Wilcox, from Patients Rising, said that hearing about patients and hearing from patients are both consequential. “Surgeons commandeer respect. The pairing of surgeons and patients is a match made in heaven.”

AI and Surgery

The “timely and pertinent topic” of artificial intelligence (AI) was at the forefront of the panel “AI and Surgery: Policy Considerations,” led by Genevieve Melton-Meaux, MD, PhD, from the University of Minnesota in Minneapolis. An esteemed group of panelists shared their experiences and expertise in an effort to help the surgeon audience understand the issues related to the use of AI in surgery, and more broadly, in healthcare. The group also tackled the current regulatory landscape surrounding AI, while also identifying opportunities for engagement.

“In many ways, you have the power. You have the judgment to say where we apply the gas and where we apply the brakes,” said Aneesh Chopra, from CareJourney in Arlington, Virginia. “We want to raise our hands and say this is something that will be helpful to the practice of surgery. If you did that, you would make it a lot easier for the regulators to minimize the bad and maximize the good. We can help shape the future.”

Another panelist, Jeffrey Smith, from the US Office of the National Coordinator for Health Information Technology, agreed that many applications and technologies, such as AI, are destined to be beneficial to surgery, especially in the area of decision-making. He pointed out the “tremendous opportunity” when it comes to AI but shared the reminder that “we are still trying to understand” this evolving technology and “so we have to remain clear-eyed.”

Surgical Quality

“Does what we measure today help patients? Does it help care teams? Or should we be measuring something else?” These thought-provoking questions began the session, “Surgical Quality in Patient-Centered Care.”

According to Matthew P. Schiralli, MD, FACS, from Rochester Regional Health in New York, when building out quality programs—either for the ACS or hospitals—rallying healthcare professionals and gaining their support are crucial. “They understand that these programs are directly benefitting the patients who we serve.”

Data have shown that in hospitals with quality programs, the cost of care is lower, and the quality of care is higher. “And that’s what excites healthcare professionals,” he said.

Missy Danforth, from The Leapfrog Group in Washington, DC, noted that the ACS Geriatric Surgery Verification Program (GSVP), which features 32 surgical standards designed to improve surgical care and outcomes for older adults, is “one of the most innovative types of new measures I’ve seen.”

GSVP is revolutionizing elderly patient care, Dr. Schiralli agreed. “We realized that our area in New York State is aging faster than the rest of the state, which is aging faster than the rest of the country. We naturally said we’re going to latch on to a program for the older patient, and we wanted to be an example for the rest of the country. What has the end result been? We’re on the journey, and we’re never quite done. Our demographic is always changing, but importantly, we’re embracing team-based care and creating systems in our hospitals that are not just surgeon-dependent.”

Congressional Asks

After an almost full day of informative panels, staff members from the ACS DC office detailed the “asks” and provided background information in preparation for the visits to the Congressional offices. The attendees broke into groups by state and discussed how to:

• Stabilize the Medicare physician payment system (Strengthening Medicare for Patients and Providers Act)
• End costly insurer fees (No Fees for EFTs Act)
• Support the surgical workforce and patient access to care (Ensuring Access to General Surgery Act, Resident Education Deferred Interest Act, Specialty Physicians Advancing Rural Care Act, and the Workforce Mobility Act)
• Increase access to cancer screening (Colorectal Cancer Payment Fairness Act and the Find It Early Act)
• Reauthorize critical trauma programs (Pandemic and All-Hazards Preparedness Act and the Emergency Medical Services for Children Act)
• Support $10 million for neglected surgical conditions

Several invited congressional speakers—Reps. John Joyce, MD (R-PA), Darin LaHood (R-IL), Angie Craig (D-MN), and Raul Ruiz, MD (D-CA), as well as Sen. John Boozman (R-AR)—shared their thoughts on the important role surgeons play in advocating for their patients and shaping federal healthcare policy.

“The Leadership & Advocacy Summit is one of my favorite meetings,” said Jason P. Wilson, MD, MBA, FACS, a surgical oncologist from Sentara Health in Hampton, Virginia, and the 2023 ACS Advocate of the Year. “This year, we heard presentations about dealing with moral injury stemming from complications, what sustainability in healthcare looks like, and heard from amazing surgeons who have transitioned into the CEO role. We then moved into the advocacy component and learned how to be effective surgeon advocates. I always learn so much at this meeting and appreciate the chance to meet new colleagues and take practical steps to help the ACS with its advocacy agenda.”

Advocacy and Health Policy Abstract Competition

Residents and trainees also had an important role in the summit content. Nine authors were invited to present their abstracts, and the top three were recognized:

• First place ($500): Lucero Paredes, MD—An Unconditional Cash Transfer Program for Survivors of Firearm Injury: A Strategy to Address Community Gun Violence
• Second place ($250): Kranti Rumalla—Evaluating Surgeon Workforce Adequacy in Metro and Non-Metro Areas: An Analysis of 2035 Projections
• Third place ($100): Nicole Hatala, MD—STOP THE BLEED® Kits on University of Missouri-Columbia Campus: A Five-Year Follow-up

Individuals still can register for the Leadership portion of the Summit to access on-demand content at facs.org/summit. Registrants can earn up to 5.25 AMA PRA Category 1 Credits™ for attending or viewing the Leadership Summit; another 1.75 AMA PRA Category 1 Credits™ are available for each of the Practice Management and Controlling Risk workshops (in-person only). The deadline to access content and claim CME credits is June 14, 2024.

The 2025 Leadership & Advocacy Summit will be held in person only in Washington, DC, April 5–8.

Jennifer Bagley is the Editor-in-Chief of the Bulletin and Senior Manager in the ACS Division of Integrated Communications in Chicago, IL.

The following photos were provided by ACS members who attended Hill Day, including Drs. Doug Wood, Jason Wilson, Amy Liepert, Michael Visenio, Fedra Fallahian, Katayoun Madani, and Marion Henry.