One of the highlights of the 2011 Annual Meeting of the Kansas Chapter, American College of Surgeons was the installation of James J. Hamilton,Jr. MD as President of the Chapter. Dr. Hamilton is a general surgeon practicing in Topeka. Dr. Hamilton was also presented the 2011 Arthur Ellenberger Award from the American College of Surgeons. Dr. Hamilton was recognized for protecting patient access to high-quality surgical care through outstanding leadership, distinguished service and commitment to state grassroots advocacy. Dr. Hamilton was recognized for his service on the Cancer Committee and for his advocacy in support of no-smoking laws passed in the City of Topeka and the State of Kansas. State Surgery Legislative Action Center The American College of Surgeons provides links to two sites that offer information on elected officials, issues & legislation, elections & candidates and media guides. These sites allow searching for officials, issues, candidates and media outlets. Please select the Other Links tab and choose either the State Surgery Legislative Action Center link or the CQ State Tracker link to begin your search. Board of Governor's Report Tyler Hughes, MD FACS Report from the 2011 Board of Governors Meeting The Board of Governors meeting was held on October 23, 2011, during the 97th Clinical Congress in San Francisco, CA. The Board of Governors acts as a clearinghouse for the Board of Regents on general assigned subjects and on local problems. The Governors represent the Fellows of the College, and are the official communications link between the Fellows and the Board of Regents. Here are a few highlights of that meeting. Brace for impact. The best guess is that there will be a Medicare cut, as the sustainable growth rate (SGR) is unlikely to be fixed. Cuts are almost certainly coming January 1. It may be 1% or 2%, and the worst case is 30%. ACSPA is working on this, but with only about 3% of Fellows contributing to the PAC this year, they are at a disadvantage. They need our donations as well as our ideas of how to rethink reimbursement. My personal opinion is that reimbursement isn't going to change, but rather, the change is already happening. The reason there will be no SGR fix is that selling the American people on a $200+ billion doctor pay fix just isn't going anywhere. You and I may argue the complexities and importance of the issue—especially regarding access to care—but the super committee has to come up with $1.4 trillion in savings or cuts. If the super committee fails to hit that mark, which is certainly possible, then automatic cuts, including the dreaded 30% SGR cut, is possible. Thirty percent is unlikely because Congress may get some of the cuts done, so the cut we will see is 30% minus percent of shortfall. A permanent cut of 2% to 6% is the ballpark figure that seems more likely. Parenthetically, I would add that the MedPAC proposal of 5.9% for three years was vigorously opposed by the ACS member of that board, Karen Bormann. I spoke with her personally on this, and I believe you should know that, despite the complaints that ACS doesn't try to protect us as much as they should, in this matter, we were definitely represented. The problem is that the rest of the world does not necessarily jump to our recommendations. The MedPAC board is composed of a very diverse group, and only a few are physicians. In my view, the problems surrounding SGR do not represent a failure of our PAC. I shudder to think what would be playing out without their effort. I repeat that having so few Fellows contributing to the PAC certainly stifles their influence. That is a sad, but true, fact about Washington politics. Surgeon burnout continues to be a major issue, and the College is actively looking at this problem. Be aware and supportive of your colleagues. Up to 6% of them may be so burned out that they are considering suicide. The College is very focused on this issue. The socioeconomic committee will be reproducing three articles by Dr. Zismer on employment issues. These articles are essential to anyone considering an employment model. The committee will produce a white paper on employment issues that will serve as guideline. A model contract is also being worked on. Perhaps the biggest message coming from the various experts and our colleagues working on the changes in health care is that every Fellow needs to help us come up with ideas that will reduce health care costs. Ways to examine and use data for better outcomes are paramount. The status quo is dead. The ACS needs to be a leader in redefining how health care is delivered, and the solution must be based on data. A new arm of the College, the Health Policy Action Group (HPAG), is a grassroots initiative created to bring as many Fellows as possible into the policy arena to look for solutions. Once again, the matter of dues was discussed. After studying the reports from the Fiscal Affairs Committee, the Governors recommended a 3% per year increase in dues yearly, but the Regents may decline to impose the increase in any given year based on College financial health. It is hoped that this will allow stability of the College's finances without the large raises that have been required in the past. The College is and always has been in the lowest third of professional societies regarding cost of dues. We aim to keep it there and to work hard to increase the real value of College membership. Obviously, this was not a very uplifting year of challenges the Board of Governors had to face. Further, so many of the buffeting forces on surgeons are caused by factors beyond our scope or control. In such trying times, it is important that we focus on the items we can influence and stick together in those efforts rather than randomly vent or, even worse, allow ourselves to become alienated from each other. In my second year as a Governor, I am beginning to see how big the issues are and how complex reaching consensus can be. Looking back over the first year of my term, I see that the College is doing a much better job of reaching out to the core membership. The importance of general surgery and rural surgery is recognized. The issues of academics versus private practice are being stated and examined. The need for input from every member is viewed as crucial. William Osler said, "To solve a problem, one must first understand the problem." In a time when the very fundamentals of practice, technology, quality analysis, and education are being changed, it is understandable that the College, which is an enormous organization, will struggle both to understand these problems and disseminate that information to its 78,000+ members. Still, they are dedicated to doing so. The arduous steps of how to respond to the problems once we understand them is another level of complexity. More than at any time in my involvement with the College, the ability of a Fellow at any level to make a difference is real. That is evident in the fact that the following members of College leadership personally reached out to me during this Clinical Congress: Patricia J. Numann, President; A. Brent Eastman, President-Elect; J. David Richardson, Chair of the Board of Regents; LaMar McGinnis, Past President; Carlos Pellegrini, Past Chair of the Board of Regents; David Hoyt, Executive Director; Clifford Ko, Director of Research and Optimal Patient Care; Lynn Kahn, Director of Integrated Communications; and Howard Tanzman, Director of Information Technology—just to name a few. These men and women were not patronizing me. They each sought my insights and support to make surgical patient care better. That is not a kudo for me, but to them for honestly listening to and supporting a surgeon working in a 25-bed rural hospital whose highest academic credential is clinical instructor. I believe that any Fellow who is willing to listen as well as speak up, who wishes to promote surgical patient care, can find a place of significance in College work. The pay is zero, but the reward for one's patients is priceless. Tyler G. Hughes, MD, FACS Co-Community Editor, Rural Surgeons e-FACS.org Surgical CME Opportunity The 2012 Annual Meeting of the Kansas Chapter of the ACS will be September 8-9, 2012 at the Doubletree Hotel at Wichita Airport, Wichita, KS. Topics will be designed to meet the continuing education needs of surgical specialists. All surgeons are invited to attend and participate in the continuing medical education program. General program topics will include Minimally Invasive Surgical Techniques and an Update on Cancer. This years program will provide Maintenance Of Certification credits for the American Board of Surgery Maintenance of Certification Program.