Surgery News - March 2009 - (Page 12) NEWS FROM THE COLLEGE MARCH 2009 • SURGERY NEWS Statement Issued on Emergency Surgical Call This statement was developed by the Board of Governors’ Committee on Socioeconomic Issues in collaboration with the Board of Governors’ Committee on Surgical Practice in Hospitals and Ambulatory Settings. The statement was approved by the Board of Governors and the Board of Regents in October 2008. Issue Compassion and our professional ethics mandate that all patients faced with a surgical emergency are provided care. The American College of Surgeons fully supports access for all Americans to emergency care, but major issues of surgical manpower and resource utilization represent a threat to continued access. The American College of Surgeons presents the following analyses and recommendations. Historical Perspective Emergency surgical call serves to meet patient needs. The Emergency Medical Treatment and Active Labor Act regulations support this patient care by Medicare-participating hospitals and provide a funding stream to the hospitals by means of the Medicare system. By means of cost shifting and sharing the burden with other surgeons, surgical practices generally have been able to provide such service. Current Environment Our population has aged steadily. The more elderly the population, the more health care required, both emergent and nonemergent. In addition, an everincreasing population of indigent patients uses the emergency room as the sole avenue to medical care. At the same time, the number of surgeons produced by our graduate medical education programs has remained stable for nearly 30 years. (Statement on the surgical workforce [ST-57]. Bull. Am. Coll. Surg. 2007;92(8):34-35.) In general surgery, the ratio of surgeon to population has been steadily declining since 1985. Other specialties with even fewer providers feel they can no longer meet the community demands for their services. (Statement on the surgical workforce [ST-57]. Bull. Am. Coll. Surg. 2007;92(8):34-35.) As a result, there exists an increasing chasm between expectations for access to emergency surgical care and the surgeon workforce available to provide such care. The College recognizes the need for emergency surgical care. (Statement on emergency surgical care [ST-56]. Bull. Am. Coll. Surg. 2007;92(5):27.) The hospital, mandated by the government, has entered into a contract with the community to provide care without involving the actual care provider in the negotiations. The surgeon feels deeply obligated to care for all individuals who require care. However, the surgeon attempting to provide this care is forced to be practical in the face of increasing demands. To provide this care, the surgical practice must remain fiscally viable, professionally attractive, and competitive in retaining and hiring colleague surgeons for the community. The challenges to this effort are many and varied. Emergency surgical care detracts from this ability to recruit in many communities because emergency call involves greater risks than care provided during elective, scheduled operations. Operations often must be accomplished under conditions that do not allow for standard preoperative preparations. These patients often have the highest risk for complications due to advanced disease states and associated risk factors. Patient expectations frequently reflect what can be expected with proper preoperative preparation and planning even when this is not the case. Such unrealistic expectations can lead to an increased malpractice risk. Being available for emergency call may appear innocuous, yet excessively frequent oncall duty has a negative impact on the surgeon’s time with family and the ability to provide community service outside of the profession. Unfortunately, this surgical service is increasingly mandated without appropriate compensation. The obligation to provide care must be balanced by the means to do so; cost shifting to the surgeon is an unacceptable option. Recommendations The College recommends that health care payors and institutions commit necessary and appropriate support to surgeons for emergency coverage of surgical care. (Statement on emergency surgical care [ST-56]. Bull. Am. Coll. Surg. 2007;92(5):27.) Whatever the model chosen to provide this patient service, it must account for the disruption involved with being on call when actual service may or may not be required. Compensation for the service provided must be based on fair value for the risks involved and time allocated. Portal Is Rich Resource For Rural Surgeons you a rural surgeon looking for an easier way to stay on topics of interest? ArethecurrentSurgeons Community Look no furtherthe than Rural on e-FACS.org, College’s members-only Web portal, where you will find many useful features and resources. For starters, the “Latest from PubMed” feature provides scrolling links to the most recent journal articles relating to surgery in rural areas. See something you like but don’t have time to read it right away? Just click the “Add to Bookmarks” button to save the item to the portal’s “My Bookmarks” page for later reading. As an example of the type of useful information you will find in this community, check out the article, “Trends in Adoption of Laparoscopic Cholecystectomy in Rural Versus Urban Hospitals,” by Randall S. Zuckerman, M.D., FACS (Co-Community Editor, Rural Surgeons) and his colleagues. Herbert Chen, M.D., FACS, an endocrine surgeon, has provided an excellent review of the current state of parathyroid surgery. This article should help in studying for recertification or for exploring the options for patients with parathyroid disease. The community also includes a link to the rural surgeons discussion forum, where members of the College can share ideas or ask questions. You can even subscribe to the forum to receive an email when new postings are added. As an extension of this forum, Tyler G. Hughes, M.D., FACS (Co-Community Editor, Rural Surgeons), has created the Rural Surgeons’ Network for those who wish to be alerted to postings and events on rural surgery. The alerts are noncommercial, brief, and transmitted only when a new subject of interest is posted. To access the Rural Surgeons community, visit http://efacs.org/rural. To join the community or to submit material, photos, or ideas, send your preferred e-mail address to Dr. Hughes at tylerh@mcphersonmemorial.org. Interactive Symposium Coaches Surgeons on End-of-Life Issues spiritual, and practical aspects of the physician-paPhysicians will learn aboutofthe cultural, “The tient relationship at the end life during Art of Medicine at the End of Life,” a continuing medical education (CME) annual symposium to be held May 8, 2009, at The New York Academy of Medicine (NYAM). Geoffrey Dunn, M.D., FACS, medical director, Palliative Care Consultation Service, Hamot Medical Center, Erie, Pa., and chair of the College’s Surgical Palliative Care Task Force, will join Arthur Caplan, Ph.D., a well-known expert on bioethics, and other experts participating in this highly interactive course. The course is sponsored by the Cunniff-Dixon Foundation and the NYAM. Using short, didactic lectures, discussions, and case presentations, speakers will address the following objectives for the course: Prepare patients and their families for the transition to the end of life. Implement a strategy to provide a more personal and informed level of patient care, thus enhancing the quality of life for terminally ill patients. Recognize the appropriate time to suggest palliative care or hospice for terminally ill patients, and facilitate the process. Anticipate common ethical and legal issues that arise in the context of end-of-life medical care. Apply an understanding of the psychiatric aspects of mortality to improve the quality of interactions with terminally ill patients and their families. Recognize and accommodate the needs of patients and families from various cultures and religions coping with the end of life. Understand research and policy trends in palliative care. The fee for the course is $225 for physicians and $125 for resident physicians who register before April 1, 2009. Fees will increase after the registration deadline and again on site. For detailed course information and to register, visit www. nyam.org/events/?id=494. 2009 PQRI Program Changes Listed on Web Site ing Initiative (PQRI) Web site, www.facs. The recently updated Physician Quality Reportorg/ahp/pqri/, includes information about the 2009 program. Surgeons will find an introduction to PQRI, results and payment information for participants in the 2007 initiative, valuable resources and tools for participating in PQRI, and links to other useful Web sites. Previous PQRI participants should note that some of the performance measures that have carried over from 2008 may have changed. It is important to look closely at the measure specifications for 2009 even if you are reporting a measure from a previous year. The ACS Web site lists the changes made to the perioperative measures under the 2009 PQRI performance measures section with a link titled “Code Changes to 2008 Perioperative Measures Specifications.” More information may be obtained by contacting cburley@facs.org. http://www.e-FACS.org http://www.nyam.org/events/?id=494 http://www.nyam.org/events/?id=494 http://www.facs.org/ahp/pqri http://www.facs.org/ahp/pqri http://efacs.org/rural
Table of Contents Feed for the Digital Edition of Surgery News - March 2009 Surgery News - March 2009 Contents Trauma Training More for Less? Stress Test Mentoring Surgery News - March 2009 Surgery News - March 2009 - Contents (Page 1) Surgery News - March 2009 - Contents (Page 2) Surgery News - March 2009 - Contents (Page 3) Surgery News - March 2009 - Contents (Page 4) Surgery News - March 2009 - Contents (Page 5) Surgery News - March 2009 - Trauma Training (Page 6) Surgery News - March 2009 - Trauma Training (Page 7) Surgery News - March 2009 - Trauma Training (Page 8) Surgery News - March 2009 - More for Less? (Page 9) Surgery News - March 2009 - Stress Test (Page 10) Surgery News - March 2009 - Stress Test (Page 11) Surgery News - March 2009 - Stress Test (Page 12) Surgery News - March 2009 - Mentoring (Page 13) Surgery News - March 2009 - Mentoring (Page 14) Surgery News - March 2009 - Mentoring (Page 15) Surgery News - March 2009 - Mentoring (Page 16)
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