The other day, I counted up how many dues-paying medical organizations I belong to and I came up with 12! That made me think about what I actually “get” from belonging to each of these organizations. I started to measure the value of my memberships.
I think every orthopaedic surgeon would agree that AAOS membership is an excellent value, based on the education, advocacy, and quality efforts it undertakes on behalf of our profession. My specialty society, the Orthopaedic Trauma Association (OTA), and my state orthopaedic society also deliver tremendous value, so I think those dues are money well spent!
I am also a fellow of the American College of Surgeons (ACS). That sometimes raises eyebrows among my colleagues. So besides the really cool “FACS” in my signature block, what is the value of an ACS fellowship for orthopaedic surgeons?
Some words about the ACS
The ACS was founded in 1913 and is one of the oldest surgical societies in the United States. The purpose of the ACS is to “improve the quality of care for the surgical patient by setting high standards for surgical education and practice.” The ACS is the largest surgical organization in the world—with approximately 78,000 members, most of whom are in the United States.
The ACS is governed differently than the AAOS, relying on a 22-member Board of Regents, rather than an elected board of directors. The regents represent a diverse group of different specialties and geography, reflecting the ACS goal to represent the “House of Surgery.” L. Scott Levin, MD, FACS, of the University of Pennsylvania, represents orthopaedic surgery on the Board of Regents.
The FACS acronym stands for Fellow of the American College of Surgeons. ACS fellows value this distinction because it signifies that they have been recognized by their national organization as qualified, capable surgeons. Orthopaedic trauma surgeons who join the ACS often seek to become fellows to show their trauma surgery colleagues their commitment to the system.
Orthopaedic surgeons who apply for fellowship in the ACS should realize that the application process may take a year and include an evaluation of their practice by their peers. The applicant must be certified by either the American Board of Orthopaedic Surgeons or the American Osteopathic Board of Orthopaedic Surgery and be in practice at least one full year after completion of training.
Applicants will need to submit the names of five local ACS fellows as references, two of whom must be orthopaedic surgeons. Applicants must also submit a 12-month case list to the College. The final step in the process is an interview with the local ACS committee.
The ACS provides extensive educational offerings for members, although most are more appropriate for general surgeons. Perhaps the best known educational resource is the Advanced Trauma Life Support program promulgated through the ACS Committee on Trauma (COT).
The COT’s orthopaedic section includes AAOS fellows who are engaged in improving trauma care and systems across the United States. The COT serves as the standard-setting body for ACS verification of trauma centers. (See “Demystifying Trauma Center Levels,” AAOS Now, July 2015.) The orthopaedic section of the COT is currently chaired by Philip R. Wolinsky, MD, FACS, an orthopaedic trauma surgeon at the University of California–Davis.
The orthopaedic section was very active in the development of the criteria outlined in the Resources for Optimal Care of the Injured Patient 2014. This book clearly designates the requirements that ACS-verified trauma centers must meet, specifically for the care of patients with orthopaedic injuries.
The ACS founded and promotes the National Surgical Quality Improvement Program (NSQIP). NSQIP data are among the best ways to measure surgical quality in the United States, in part because the data are both risk-adjusted and case–mix-adjusted. These adjustments allow comparison among different patient populations as well as between facilities.
Data are extracted from patient charts, and data collection extends 30 days after the procedure, thus capturing more accurate information about the patient’s recovery. Surgical programs that participate in NSQIP report fewer complications, shorter hospital stays, and improved outcomes.
The National Trauma Data Bank (NTDB) is another ACS initiative that measures the quality of trauma programs across the United States. The NTDB is the largest aggregate of trauma-related data ever compiled in the United States. NTDB reports to member institutions provide benchmarks for trauma programs, enabling them to compare themselves effectively against other similar trauma systems. The NTDB is recognized as the leading trauma registry in the United States. The Trauma Quality Improvement Program is another ACS program that measures quality in trauma care among participating trauma systems.
The ACS annual meeting is called the Clinical Congress. Like the AAOS Annual Meeting, the ACS Clinical Congress provides significant educational offerings, particularly in the areas of trauma, cancer care, and quality assessment. The College also participates in political advocacy efforts, and the ACS and the AAOS often coordinate advocacy agendas.
After reviewing the activities and offerings of the ACS—as well as participating in many of its programs, I know how to answer the WIFM (what’s in it for me?) question. I believe that orthopaedic surgeons—particularly those engaged in trauma and cancer care—should consider fellowship in the ACS. The ACS, AAOS, and OTA each have value to us and our practices. Cross-membership helps ensure that the advocacy, education, and quality efforts of these three outstanding organizations run parallel to each other, rather than at cross purposes.
If the OTA is the “house of trauma,” and the AAOS is the “house of orthopaedics,” the ACS is the “house of surgery.” Working together, these three important organizations can improve care for all of our patients. Better outcomes, a louder voice, and a united front—that’s my WIFM answer.
Douglas W. Lundy, MD, is copresident of Resurgens Orthopaedics in Atlanta, and a member of the AAOS Now editorial board.