dr Brent eAstmAn
r Brent Eastman, MD FACS, the President of
the American College of Surgeons (ACS), was
recently awarded an Honorary Fellowship of
RCSI. He spoke to Surgical Scope about his
role as President of the ACS, challenges facing
America's healthcare system, how a train wreck
led to his lifelong work in trauma care ... and his hope to one day
cast a line in one of Ireland's trout streams.
As president of the ACs, whAt Are
your key oBjeCtives for your term?
My four `Calls To Action' in my Presidential
Address, "The Next Hundred Years" at the ACS Clinical Congress in
Chicago in September 2012 were:
access to healthcare;
surgical education and training in the 21st century; and,
the role of the president of the ACs Affords
A unique perspeCtive on heAlthCAre in the us.
whAt does the us system do Best in surgery in
In the field of surgery, through the ACS, we have established
standards for high quality, safe and efficient surgical care. This has
been accomplished through the creation of databases, registries (i.e.
trauma and cancer) and the verification that hospitals meet these
whAt single ChAnge would most Benefit
Increased access for the uninsured population.
whAt is your view on the pAtient proteCtion
And AffordABle CAre ACt (ACA), so-CAlled
`oBAmACAre'? where does it go from here?
The big picture mission of the ACA is to provide more care and
increase efficiency. It proposes to do this by increasing access to care,
payment reform, and delivery system redesign. Improving access to
care requires implementation of insurance reform, scheduled to take
place in 2014. How effective this will be, remains to be seen. Much
effort is currently being put into the implementation of this portion
of the law. Payment reform is occurring through the development of
different payment models, including accountable care organisations,
bundled payments and similar models. Important in this aspect of
the law is to ensure that payment is fairly distributed to providers.
Finally, delivery system redesign is being accomplished by increasing
performance measurement and increasing its transparency,
in particular with the public. All of these elements need to be
implemented in line with our principles at the American College of
Surgeons of being patient-centred, physician-led, quality-driven and
efficiency-based. Implemented correctly, the new law can help with
As orginally conceived, the ACA addressed some very real problems
in the US health system such as limited access for the millions of
uninsured people, elimination of pre-existing conditions as excluding
one from obtaining heath insurance, controlling our rising costs etc.
Most significantly, the ACA has not determined a way to pay for
legislation as currently proposed. Also, this legislation must support
our graduate medical education programmes, as we face a major
physician/surgeon shortage in the near term. Ultimately, the ACA
must focus on what is best for our patients.
you hAve hAd A lifelong interest in trAumA
CAre And trAumA systems. whAt motivAted you to
foCus on this AreA in pArtiCulAr?
It all began with a huge train wreck outside my hometown of
Evanston, Wyoming. I was 11 years old and was taken to the site of
the wreck by my father, a Union Pacific Railroad locomotive engineer.
One passenger train had crashed into the rear end of another in the
worst blizzard of the year. Remarkably, some of the passengers on
the rear passenger train were surgeons headed home to Chicago
from the Clinical Congress of the ACS in San Francisco. I witnessed
the surviving surgeons crawling out of the wreckage and treating
the surviving badly injured passengers. I decided I wanted to be a
surgeon like them.
ACs president And rCsi honorAry fellow on inspirAtion,
trAumA CAre And operAting in disAster zones
continued on next page