Why otolaryngologists-head and neck surgeons should join the American College of Surgeons.

The American College of Surgeons (ACS), like the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), has a rich heritage. It was founded in 1913 and is "dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment."

For the first time in history, an otolaryngologist, Dr. Gerald B. Healy, has been elected president of the ACS. Today there are 74,265 members of the College, but only 4,837 (6.5%) are otolaryngologists-head and neck surgeons. These 4,837 members represent 44% of the approximately 11,000 otolaryngologists in the United States who could be members.

The ACS now assists with planning for the Combined Otolaryngology Spring Meetings and Triological Society meetings and has assisted with conducting several other major otolaryngology meetings. Along with the AAO-HNS, American Association of Neurological Surgeons, American College of Osteopathic Surgeons, Congress of Neurological Surgeons, Society of American Gastrointestinal Endoscopic Surgeons, and The Society of Thoracic Surgeons, the ACS sponsored the first annual Joint Surgical Advocacy Conference in Washington, D.C., in March of this year.

The ACS is also trying to serve as a clearinghouse for the various subspecialty surgical-residency review committees, to promote the interests of surgery at the Accreditation Council for Graduate Medical Education and the various surgical boards at the American Board of Medical Specialties.

The main divisions of the ACS are: Education, Research and Optimal Patient Care, Advocacy and Health Policy, and Member Services:

* The Division of Education develops materials to teach the core competencies required in residency training programs. Several of these, such as practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice, span all surgical training programs. This division is also involved in developing materials for maintenance of certification, such as a case log system and other CME materials.

* The Division of Research and Optimal Patient Care offers substantial scholarships to assist in the development of young surgeon investigators and residents interested in research. It also administers the National Surgical Quality Improvement Program and maintains the National Trauma Data Bank and the National Cancer Data Base.

* The Division of Advocacy and Health Policy coordinates efforts to advance the interests of all surgeons. Although the ACS headquarters is located in Chicago, this division maintains offices in Washington, D.C.; and, to be in a better position to influence legislative affairs, the ACS is building a $100 million office building on Capitol Hill. This new building attests to the College's interest in implementing real change in national health policy.

* The Division of Member Services offers many advantages to all surgeons, including $2.2 million in scholarships for purposes ranging from faculty development to health policy development. In concert with the Triological Society, the ACS offers a research grant to young investigators with a KO8 award for up to $80,000 per year for 5 years--a potential $400,000 grant.

The yearly ACS Clinical Congress offers much material relevant to otolaryngologists and is free to all fellows of the College. For example, the head and neck ultrasound course was developed at the Congress, and much information on health policy and perioperative care is presented there.

I believe we are all first and foremost physicians, then surgeons and, most specifically, surgical specialists. It has been an education to me as a new Regent of the ACS to learn that even at the highest levels of organized surgery, physicians see themselves largely as surgical specialists, and they debate what it means to be a general surgeon. An important focus of this debate seems to be who will take responsibility for acute care surgery and the treatment of emergent and urgent surgical problems. Although the closest thing to a true general surgeon seems to be a rural surgeon or the new breed of acute care surgeon, the unique expertise otolaryngologists have in managing the airway, trauma of the head and neck, serious infections of the head and neck, and other emergent and urgent problems makes us more similar to the general surgeon of the past than many other surgical specialists, whose practices are more isolated from the emergency room. Even acute care surgeons are likely to consult with an otolaryngologist for serious problems in the head and neck.

Our practices have larger medical components than those of most surgical specialists, and we see a wider variety of patients than other surgeons, but I am more impressed by the commonalities of the problems and challenges we share with other surgical specialists than with the differences, such as providing operative and perioperative care, managing deep venous thrombosis, preventing surgical site infections, managing perioperative pain, and dealing with perioperative respiratory and cardiac dysfunction. We all also deal with interactions between operating room personnel, anesthesiologists, and outpatient surgical centers, as well as the medical insurance industry and governmental regulatory agencies.

Whereas the AAO-HNS is our mother organization for issues dealing with our surgical specialty, the ACS is our father organization, which can assist us with broader issues common to all surgeons. Most surgical specialists also belong to subspecialty organizations and, recently, there has even been a movement to develop a subspecialty organization for general surgeons within the ACS. (In essence, the general surgeon is becoming another of a variety of surgical subspecialties.) Nevertheless, because the College is larger and has a greater endowment than the other organizations, it is a more formidable force in dealing with legislatures and other regulatory agencies.

In summary, the ACS is the premier organization that represents all surgeons around the world. ACS membership complements membership in the Academy. The two organizations are working closely together to ensure a healthy future for otolaryngology-head and neck surgery, other surgical subspecialties, and surgery in general in today's rapidly changing practice environment. Otolaryngologists benefit dally from the activities of the ACS, and it is appropriate for all of us to share our insights, concerns, and opinions with the College and to support the future of surgery and otolaryngology by supporting the College through our membership.

Mark C. Weissler, MD, FACS 

J.P. Riddle Distinguished Professor

Otolaryngology-Head and Neck Surgery

University of North Carolina 

Chapel Hill, N.C.