Tyler Hughes, MD, FACS

I was in the surgeons’ lounge in the middle of the night – waiting, as we surgeons so often do. I plucked my phone from my pocket to see what was happening on the ACS Communities. Sure enough, another surgeon was up at night somewhere contemplating a case, another was railing against a CEO, and yet another was considering entering into an employment contract. All of them were asking the same question, “What do you think?” of their College. By College, I am not referring to the leadership or the staff but to that intangible entity that lives in the heart of every Fellow of the College. It consists of old residency friends, mentors, policy makers, new surgeons, and old surgeons. All share a common, decent desire to be not just a surgeon but also a great surgeon by whatever definition one happens to hold sacred.

I smiled to myself and shook my head. From the lonely moments before an emergency case, I had a quick dose of reassurance that I was not alone, that I was a part of something bigger than myself, and that many surgeons were and are doing exactly what I do every day. Those surgeons are truly a community.

As with any community, the participants of the ACS Communities are diverse and the viewpoints and knowledge among them vary widely. But all of them have a sense that their experience, knowledge, skills, tricks of the trade, and philosophic thoughts transcend to a common purpose for the good of the patients and the profession. One can lose sight of this in the hurly-burly world of surgery, which has so much drama inherently in its performance.

ACS Communities is about a year old now and almost all Fellows belong to at least one Community in the system. This project was in the pipeline for several years. The origin of the Communities idea extends back to the 1990s. It was the brainchild of Fellows George Sheldon, Tom Russell, and David Hoyt, who all realized that honest and open communication breeds understanding and mutual respect. But none of us involved in this effort to develop the Communities really knew what the impact would be on the American College of Surgeons or the surgical community at large. Reminiscent of the first telegraph message, as the system was turned on live I thought, “What hath God wrought?” For, in fact, communication at the speed of light among 60,000 surgeons is a bit like lighting a match in a dynamite factory. You might get to see what is in a previously dark room, but you could also get an explosive result.

As Editor in Chief of the system (with the able support of Jerry Schwartz at the Chicago ACS headquarters), I’ve read essentially every one of the now thousands of posts placed into the system. Having spent some time in the company of surgeons, I was prepared for their propensity for intense expression of their views. But I was amazed to discover that while discussions in the Communities are frequently very … ah … frank, foul language and nasty comments against individuals are rare. There have been a few exceptions but it is usually a surgeon writing in the heat of the moment and temporarily forgetting that once the send button activates, there’s no way to take it back. So, I would say the great majority of conversations have been frank without being unprofessional.

Just as you can’t believe many things you read on the Internet, you can’t believe everything you read from other surgeons. When clinical cases are discussed, one frequently sees widely divergent opinions. Some of the posts are of dubious value, while others are cutting-edge ideas from world-class experts. I would advise that when posting a case (always with an eye to avoiding a HIPAA violation) that participants look at the entire range of responses. From that variety of responses, you usually see the best course. Sometimes, it is obvious there isn’t a “right” answer but several reasonable ones.

Politics rears its ugly head frequently on the General Surgery Community. Interestingly, the specialty communities tend to be strictly professional in discussing cases, training, and surgical judgment. In the realm of the political, the discussions demonstrate some of the best and worst in us. One can see that College participants are similar to the general public in that they are usually about equally divided on any single issue. This means that inflexible positions taken by the College leadership favoring a particular point of view is likely to annoy about half of the Fellows. But a few opinions are almost universally voiced: a general hatred of EMR/EHRs (despite the knowledge that if they worked right as clinical documents, surgeons would love EHRs), dissatisfaction with government regulation no matter what the regulation, admiration of their mentors, and a shared belief that salaried employment is rapidly becoming the norm of surgical life.

A great aspect of the Communities is that College leadership is reading it. When a new issue or policy, such as EHR, employment, volume outcomes, etc., comes under discussion in the Communities, the Board of Governors and Board of Regents have access to unvarnished comments from front-line surgeons. At times, these views are a revelation and, at other times, they are a confirmation of leadership impressions. It is increasingly common to see the President of the ACS, the Chair of the Regents, or a Governor chime in directly or subsequently bring the matter up in a leadership conference. I would say to those who post that their thoughts published on the Communities are like ripples in a pond. You never know what great wave may eventually land on another shore.

There are dangers of instant communication in a written format. More than once a rumor that is without basis gets started. It becomes surgeon legend and then is very hard to displace with fact. Because inflection and tone are absent from written words, what is humorous to one can be unintentionally insulting to another. I’ve noted, however, that in most circumstances of misunderstanding or errors being posted, the system is remarkably self-correcting. Within a few hours, days at most, someone points out the error or the misunderstanding, and this leads to a resolution of the conflict.

ACS Communities is not a perfect system. No doubt, as technology advances, the software and hardware will change. What I hope remains constant is a way in which practically at any time and as often as a Fellow wishes, he or she can have a voice in the affairs of the College. At any time, thousands of colleagues are at the Fellow’s fingertips in ways that bring us all together as individuals who belong to a great organization. Ultimately, it is about relating to one another on a more personal, individual basis with mutual respect and support.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and Editor in Chief of the ACS Communities.

I was in the surgeons’ lounge in the middle of the night – waiting, as we surgeons so often do. I plucked my phone from my pocket to see what was happening on the ACS Communities. Sure enough, another surgeon was up at night somewhere contemplating a case, another was railing against a CEO, and yet another was considering entering into an employment contract. All of them were asking the same question, “What do you think?” of their College. By College, I am not referring to the leadership or the staff but to that intangible entity that lives in the heart of every Fellow of the College. It consists of old residency friends, mentors, policy makers, new surgeons, and old surgeons. All share a common, decent desire to be not just a surgeon but also a great surgeon by whatever definition one happens to hold sacred.

I smiled to myself and shook my head. From the lonely moments before an emergency case, I had a quick dose of reassurance that I was not alone, that I was a part of something bigger than myself, and that many surgeons were and are doing exactly what I do every day. Those surgeons are truly a community.

As with any community, the participants of the ACS Communities are diverse and the viewpoints and knowledge among them vary widely. But all of them have a sense that their experience, knowledge, skills, tricks of the trade, and philosophic thoughts transcend to a common purpose for the good of the patients and the profession. One can lose sight of this in the hurly-burly world of surgery, which has so much drama inherently in its performance.

ACS Communities is about a year old now and almost all Fellows belong to at least one Community in the system. This project was in the pipeline for several years. The origin of the Communities idea extends back to the 1990s. It was the brainchild of Fellows George Sheldon, Tom Russell, and David Hoyt, who all realized that honest and open communication breeds understanding and mutual respect. But none of us involved in this effort to develop the Communities really knew what the impact would be on the American College of Surgeons or the surgical community at large. Reminiscent of the first telegraph message, as the system was turned on live I thought, “What hath God wrought?” For, in fact, communication at the speed of light among 60,000 surgeons is a bit like lighting a match in a dynamite factory. You might get to see what is in a previously dark room, but you could also get an explosive result.

As Editor in Chief of the system (with the able support of Jerry Schwartz at the Chicago ACS headquarters), I’ve read essentially every one of the now thousands of posts placed into the system. Having spent some time in the company of surgeons, I was prepared for their propensity for intense expression of their views. But I was amazed to discover that while discussions in the Communities are frequently very … ah … frank, foul language and nasty comments against individuals are rare. There have been a few exceptions but it is usually a surgeon writing in the heat of the moment and temporarily forgetting that once the send button activates, there’s no way to take it back. So, I would say the great majority of conversations have been frank without being unprofessional.

Just as you can’t believe many things you read on the Internet, you can’t believe everything you read from other surgeons. When clinical cases are discussed, one frequently sees widely divergent opinions. Some of the posts are of dubious value, while others are cutting-edge ideas from world-class experts. I would advise that when posting a case (always with an eye to avoiding a HIPAA violation) that participants look at the entire range of responses. From that variety of responses, you usually see the best course. Sometimes, it is obvious there isn’t a “right” answer but several reasonable ones.

Politics rears its ugly head frequently on the General Surgery Community. Interestingly, the specialty communities tend to be strictly professional in discussing cases, training, and surgical judgment. In the realm of the political, the discussions demonstrate some of the best and worst in us. One can see that College participants are similar to the general public in that they are usually about equally divided on any single issue. This means that inflexible positions taken by the College leadership favoring a particular point of view is likely to annoy about half of the Fellows. But a few opinions are almost universally voiced: a general hatred of EMR/EHRs (despite the knowledge that if they worked right as clinical documents, surgeons would love EHRs), dissatisfaction with government regulation no matter what the regulation, admiration of their mentors, and a shared belief that salaried employment is rapidly becoming the norm of surgical life.

A great aspect of the Communities is that College leadership is reading it. When a new issue or policy, such as EHR, employment, volume outcomes, etc., comes under discussion in the Communities, the Board of Governors and Board of Regents have access to unvarnished comments from front-line surgeons. At times, these views are a revelation and, at other times, they are a confirmation of leadership impressions. It is increasingly common to see the President of the ACS, the Chair of the Regents, or a Governor chime in directly or subsequently bring the matter up in a leadership conference. I would say to those who post that their thoughts published on the Communities are like ripples in a pond. You never know what great wave may eventually land on another shore.

There are dangers of instant communication in a written format. More than once a rumor that is without basis gets started. It becomes surgeon legend and then is very hard to displace with fact. Because inflection and tone are absent from written words, what is humorous to one can be unintentionally insulting to another. I’ve noted, however, that in most circumstances of misunderstanding or errors being posted, the system is remarkably self-correcting. Within a few hours, days at most, someone points out the error or the misunderstanding, and this leads to a resolution of the conflict.

ACS Communities is not a perfect system. No doubt, as technology advances, the software and hardware will change. What I hope remains constant is a way in which practically at any time and as often as a Fellow wishes, he or she can have a voice in the affairs of the College. At any time, thousands of colleagues are at the Fellow’s fingertips in ways that bring us all together as individuals who belong to a great organization. Ultimately, it is about relating to one another on a more personal, individual basis with mutual respect and support.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and Editor in Chief of the ACS Communities.

I was in the surgeons’ lounge in the middle of the night – waiting, as we surgeons so often do. I plucked my phone from my pocket to see what was happening on the ACS Communities. Sure enough, another surgeon was up at night somewhere contemplating a case, another was railing against a CEO, and yet another was considering entering into an employment contract. All of them were asking the same question, “What do you think?” of their College. By College, I am not referring to the leadership or the staff but to that intangible entity that lives in the heart of every Fellow of the College. It consists of old residency friends, mentors, policy makers, new surgeons, and old surgeons. All share a common, decent desire to be not just a surgeon but also a great surgeon by whatever definition one happens to hold sacred.

I smiled to myself and shook my head. From the lonely moments before an emergency case, I had a quick dose of reassurance that I was not alone, that I was a part of something bigger than myself, and that many surgeons were and are doing exactly what I do every day. Those surgeons are truly a community.

As with any community, the participants of the ACS Communities are diverse and the viewpoints and knowledge among them vary widely. But all of them have a sense that their experience, knowledge, skills, tricks of the trade, and philosophic thoughts transcend to a common purpose for the good of the patients and the profession. One can lose sight of this in the hurly-burly world of surgery, which has so much drama inherently in its performance.

ACS Communities is about a year old now and almost all Fellows belong to at least one Community in the system. This project was in the pipeline for several years. The origin of the Communities idea extends back to the 1990s. It was the brainchild of Fellows George Sheldon, Tom Russell, and David Hoyt, who all realized that honest and open communication breeds understanding and mutual respect. But none of us involved in this effort to develop the Communities really knew what the impact would be on the American College of Surgeons or the surgical community at large. Reminiscent of the first telegraph message, as the system was turned on live I thought, “What hath God wrought?” For, in fact, communication at the speed of light among 60,000 surgeons is a bit like lighting a match in a dynamite factory. You might get to see what is in a previously dark room, but you could also get an explosive result.

As Editor in Chief of the system (with the able support of Jerry Schwartz at the Chicago ACS headquarters), I’ve read essentially every one of the now thousands of posts placed into the system. Having spent some time in the company of surgeons, I was prepared for their propensity for intense expression of their views. But I was amazed to discover that while discussions in the Communities are frequently very … ah … frank, foul language and nasty comments against individuals are rare. There have been a few exceptions but it is usually a surgeon writing in the heat of the moment and temporarily forgetting that once the send button activates, there’s no way to take it back. So, I would say the great majority of conversations have been frank without being unprofessional.

Just as you can’t believe many things you read on the Internet, you can’t believe everything you read from other surgeons. When clinical cases are discussed, one frequently sees widely divergent opinions. Some of the posts are of dubious value, while others are cutting-edge ideas from world-class experts. I would advise that when posting a case (always with an eye to avoiding a HIPAA violation) that participants look at the entire range of responses. From that variety of responses, you usually see the best course. Sometimes, it is obvious there isn’t a “right” answer but several reasonable ones.

Politics rears its ugly head frequently on the General Surgery Community. Interestingly, the specialty communities tend to be strictly professional in discussing cases, training, and surgical judgment. In the realm of the political, the discussions demonstrate some of the best and worst in us. One can see that College participants are similar to the general public in that they are usually about equally divided on any single issue. This means that inflexible positions taken by the College leadership favoring a particular point of view is likely to annoy about half of the Fellows. But a few opinions are almost universally voiced: a general hatred of EMR/EHRs (despite the knowledge that if they worked right as clinical documents, surgeons would love EHRs), dissatisfaction with government regulation no matter what the regulation, admiration of their mentors, and a shared belief that salaried employment is rapidly becoming the norm of surgical life.

A great aspect of the Communities is that College leadership is reading it. When a new issue or policy, such as EHR, employment, volume outcomes, etc., comes under discussion in the Communities, the Board of Governors and Board of Regents have access to unvarnished comments from front-line surgeons. At times, these views are a revelation and, at other times, they are a confirmation of leadership impressions. It is increasingly common to see the President of the ACS, the Chair of the Regents, or a Governor chime in directly or subsequently bring the matter up in a leadership conference. I would say to those who post that their thoughts published on the Communities are like ripples in a pond. You never know what great wave may eventually land on another shore.

There are dangers of instant communication in a written format. More than once a rumor that is without basis gets started. It becomes surgeon legend and then is very hard to displace with fact. Because inflection and tone are absent from written words, what is humorous to one can be unintentionally insulting to another. I’ve noted, however, that in most circumstances of misunderstanding or errors being posted, the system is remarkably self-correcting. Within a few hours, days at most, someone points out the error or the misunderstanding, and this leads to a resolution of the conflict.

ACS Communities is not a perfect system. No doubt, as technology advances, the software and hardware will change. What I hope remains constant is a way in which practically at any time and as often as a Fellow wishes, he or she can have a voice in the affairs of the College. At any time, thousands of colleagues are at the Fellow’s fingertips in ways that bring us all together as individuals who belong to a great organization. Ultimately, it is about relating to one another on a more personal, individual basis with mutual respect and support.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and Editor in Chief of the ACS Communities.

The Advisory Council for Rural Surgery will be 2 years old in June 2014. Its creation resulted from the realization of ACS Leaders such as J. David Richardson, Brent Eastman, Patricia Numann, and the Board of Regents that a crisis was in process regarding surgical access in rural America.

The recognized crises in rural surgery are of interest to all surgeons. The core of therural surgical crisis is not just the access to surgical care for the estimated 60 million people of North America living in rural environs, but the role and sustainability of general surgery as a specialty in itself. General surgery, the parent of almost every specialty, has suffered a gradual attrition of its field through abdication or specialization.

While not universal, the shift from surgical training to creating specialist surgeons who take care of limited areas of anatomy leaves the American public facing a fragmented surgical world and, in those places where there cannot be multiple surgical "superspecialists," patients’ lives and well-being will depend on well-trained general surgeons in small communities and rural areas.

The Rural Council is wrestling with these large and fundamental questions. How do we train and support surgeons who must work in geographically or temporally isolated areas? Of the 1,200 residents graduating from ACGME-accredited general surgical residencies, only 30% seek broad-based practice, which amounts to 360 surgeons per year. Of those 360, about 10% –-– 36 surgeons – will practice in rural areas. More than 500 hospitals are deemed Critical Access and do general surgery. On the ACS rural listserv, there are 1,000 rural-based surgeons; 52% of rural surgeons are within 10 years of retirement (not to mention attrition from other sources such as health or burnout). A simple calculation proves that not enough surgeons will be there for those rural patients. A helicopter or runway does not equal surgical access. It takes the cognitive skills of a general surgeon to know who truly requires surgical care and what type.

Given these facts, new approaches to retaining surgical access in rural areas are coming either through proactive planning by surgeons or as a result of other parties with other interests "solving" the crisis.

Centralization is attractive to policy makers, but not to the rural patient 50-100 miles away on a snowy night. In the Affordable Care Act legislation, the ACS was able to procure a 10% increase in reimbursement for surgeons in underserved rural areas, which is appreciated. However, the motivation to practice in rural locales is not and will not be driven solely by money, for the joy of rural practice lies in the fulfillment of doing a difficult job well for an entire community in which one becomes an integral part. Finding ways to make that sort of surgical life possible to young men and women is the best answer.

The Advisory Council for Rural Surgery therefore is touching many areas of surgery and the ACS. Like the rest of the College, we function in five pillars – Education, Optimal Care/Quality, Membership Services, Communications, and Advocacy. Each pillar is actively engaged. Education, under Karen Deveney, is working on templates for rural tracks in general surgery residency programs in alignment with ABS and RRC requirements as well as medical student and postresidency surgeon education. Optimal Care, under Don Nakayama, is developing infrastructure standards for rural hospitals as well as research mechanisms for rural surgeons to develop their data. Membership Service, under Mike Sarap, works on recruitment and retention of rural surgeons, call relief strategies, and community-based services on oncology issues. Advocacy is well guided by Mark Savaris, who in particular is working on repeal of the infamous 96-hour rule that threatens surgical access in some of our most-remote hospitals. The Communication pillar, under Phil Caropreso, has made enormous strides through the development of a rural listserv, which allows rural surgeons to communicate in real time on subjects ranging from case review to practice management. Through Dr. Caropreso’s tireless efforts, 1,000 surgeons communicate approximately 20-100 times a day. In total, more than 5 million e-mails have been distributed in 18 months. Soon, this will morph into the Rural Surgical Community, with much-improved software, which also will be used by the rest of the College Fellows in their respective fields of interest.

Rural surgeons, like most surgeons, pride themselves on being individualists who can solve problems with limited resources. The Advisory Council for Rural Surgery is helping these individuals find a common place for education, advocacy, quality care, communication, and fellowship. Rural surgery is transforming from disparate surgeons in isolated areas to a common group of Fellows dedicated to the highest principles of the American College of Surgeons.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and chair of the ACS Advisory Council for Rural Surgery.

The Advisory Council for Rural Surgery will be 2 years old in June 2014. Its creation resulted from the realization of ACS Leaders such as J. David Richardson, Brent Eastman, Patricia Numann, and the Board of Regents that a crisis was in process regarding surgical access in rural America.

The recognized crises in rural surgery are of interest to all surgeons. The core of therural surgical crisis is not just the access to surgical care for the estimated 60 million people of North America living in rural environs, but the role and sustainability of general surgery as a specialty in itself. General surgery, the parent of almost every specialty, has suffered a gradual attrition of its field through abdication or specialization.

While not universal, the shift from surgical training to creating specialist surgeons who take care of limited areas of anatomy leaves the American public facing a fragmented surgical world and, in those places where there cannot be multiple surgical "superspecialists," patients’ lives and well-being will depend on well-trained general surgeons in small communities and rural areas.

The Rural Council is wrestling with these large and fundamental questions. How do we train and support surgeons who must work in geographically or temporally isolated areas? Of the 1,200 residents graduating from ACGME-accredited general surgical residencies, only 30% seek broad-based practice, which amounts to 360 surgeons per year. Of those 360, about 10% –-– 36 surgeons – will practice in rural areas. More than 500 hospitals are deemed Critical Access and do general surgery. On the ACS rural listserv, there are 1,000 rural-based surgeons; 52% of rural surgeons are within 10 years of retirement (not to mention attrition from other sources such as health or burnout). A simple calculation proves that not enough surgeons will be there for those rural patients. A helicopter or runway does not equal surgical access. It takes the cognitive skills of a general surgeon to know who truly requires surgical care and what type.

Given these facts, new approaches to retaining surgical access in rural areas are coming either through proactive planning by surgeons or as a result of other parties with other interests "solving" the crisis.

Centralization is attractive to policy makers, but not to the rural patient 50-100 miles away on a snowy night. In the Affordable Care Act legislation, the ACS was able to procure a 10% increase in reimbursement for surgeons in underserved rural areas, which is appreciated. However, the motivation to practice in rural locales is not and will not be driven solely by money, for the joy of rural practice lies in the fulfillment of doing a difficult job well for an entire community in which one becomes an integral part. Finding ways to make that sort of surgical life possible to young men and women is the best answer.

The Advisory Council for Rural Surgery therefore is touching many areas of surgery and the ACS. Like the rest of the College, we function in five pillars – Education, Optimal Care/Quality, Membership Services, Communications, and Advocacy. Each pillar is actively engaged. Education, under Karen Deveney, is working on templates for rural tracks in general surgery residency programs in alignment with ABS and RRC requirements as well as medical student and postresidency surgeon education. Optimal Care, under Don Nakayama, is developing infrastructure standards for rural hospitals as well as research mechanisms for rural surgeons to develop their data. Membership Service, under Mike Sarap, works on recruitment and retention of rural surgeons, call relief strategies, and community-based services on oncology issues. Advocacy is well guided by Mark Savaris, who in particular is working on repeal of the infamous 96-hour rule that threatens surgical access in some of our most-remote hospitals. The Communication pillar, under Phil Caropreso, has made enormous strides through the development of a rural listserv, which allows rural surgeons to communicate in real time on subjects ranging from case review to practice management. Through Dr. Caropreso’s tireless efforts, 1,000 surgeons communicate approximately 20-100 times a day. In total, more than 5 million e-mails have been distributed in 18 months. Soon, this will morph into the Rural Surgical Community, with much-improved software, which also will be used by the rest of the College Fellows in their respective fields of interest.

Rural surgeons, like most surgeons, pride themselves on being individualists who can solve problems with limited resources. The Advisory Council for Rural Surgery is helping these individuals find a common place for education, advocacy, quality care, communication, and fellowship. Rural surgery is transforming from disparate surgeons in isolated areas to a common group of Fellows dedicated to the highest principles of the American College of Surgeons.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and chair of the ACS Advisory Council for Rural Surgery.

The Advisory Council for Rural Surgery will be 2 years old in June 2014. Its creation resulted from the realization of ACS Leaders such as J. David Richardson, Brent Eastman, Patricia Numann, and the Board of Regents that a crisis was in process regarding surgical access in rural America.

The recognized crises in rural surgery are of interest to all surgeons. The core of therural surgical crisis is not just the access to surgical care for the estimated 60 million people of North America living in rural environs, but the role and sustainability of general surgery as a specialty in itself. General surgery, the parent of almost every specialty, has suffered a gradual attrition of its field through abdication or specialization.

While not universal, the shift from surgical training to creating specialist surgeons who take care of limited areas of anatomy leaves the American public facing a fragmented surgical world and, in those places where there cannot be multiple surgical "superspecialists," patients’ lives and well-being will depend on well-trained general surgeons in small communities and rural areas.

The Rural Council is wrestling with these large and fundamental questions. How do we train and support surgeons who must work in geographically or temporally isolated areas? Of the 1,200 residents graduating from ACGME-accredited general surgical residencies, only 30% seek broad-based practice, which amounts to 360 surgeons per year. Of those 360, about 10% –-– 36 surgeons – will practice in rural areas. More than 500 hospitals are deemed Critical Access and do general surgery. On the ACS rural listserv, there are 1,000 rural-based surgeons; 52% of rural surgeons are within 10 years of retirement (not to mention attrition from other sources such as health or burnout). A simple calculation proves that not enough surgeons will be there for those rural patients. A helicopter or runway does not equal surgical access. It takes the cognitive skills of a general surgeon to know who truly requires surgical care and what type.

Given these facts, new approaches to retaining surgical access in rural areas are coming either through proactive planning by surgeons or as a result of other parties with other interests "solving" the crisis.

Centralization is attractive to policy makers, but not to the rural patient 50-100 miles away on a snowy night. In the Affordable Care Act legislation, the ACS was able to procure a 10% increase in reimbursement for surgeons in underserved rural areas, which is appreciated. However, the motivation to practice in rural locales is not and will not be driven solely by money, for the joy of rural practice lies in the fulfillment of doing a difficult job well for an entire community in which one becomes an integral part. Finding ways to make that sort of surgical life possible to young men and women is the best answer.

The Advisory Council for Rural Surgery therefore is touching many areas of surgery and the ACS. Like the rest of the College, we function in five pillars – Education, Optimal Care/Quality, Membership Services, Communications, and Advocacy. Each pillar is actively engaged. Education, under Karen Deveney, is working on templates for rural tracks in general surgery residency programs in alignment with ABS and RRC requirements as well as medical student and postresidency surgeon education. Optimal Care, under Don Nakayama, is developing infrastructure standards for rural hospitals as well as research mechanisms for rural surgeons to develop their data. Membership Service, under Mike Sarap, works on recruitment and retention of rural surgeons, call relief strategies, and community-based services on oncology issues. Advocacy is well guided by Mark Savaris, who in particular is working on repeal of the infamous 96-hour rule that threatens surgical access in some of our most-remote hospitals. The Communication pillar, under Phil Caropreso, has made enormous strides through the development of a rural listserv, which allows rural surgeons to communicate in real time on subjects ranging from case review to practice management. Through Dr. Caropreso’s tireless efforts, 1,000 surgeons communicate approximately 20-100 times a day. In total, more than 5 million e-mails have been distributed in 18 months. Soon, this will morph into the Rural Surgical Community, with much-improved software, which also will be used by the rest of the College Fellows in their respective fields of interest.

Rural surgeons, like most surgeons, pride themselves on being individualists who can solve problems with limited resources. The Advisory Council for Rural Surgery is helping these individuals find a common place for education, advocacy, quality care, communication, and fellowship. Rural surgery is transforming from disparate surgeons in isolated areas to a common group of Fellows dedicated to the highest principles of the American College of Surgeons.

Dr. Hughes, an ACS Fellow, is a general surgeon practicing in McPherson, Kan., and chair of the ACS Advisory Council for Rural Surgery.