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EQUITY AND SOCIAL JUSTICE

Benchmarking Accomplishments of Leaders in American Surgery and Justification for Enhancing Diversity and Inclusion

Butler, Paris D. MD, MPH; Pugh, Carla M. MD, PhD; Meer, Elana BS; Lett, Elle MB‡,§; Tilahun, Estifanos D. BS; Sanfey, Hilary A. MB, BCh, MHPE; Berry, Cherisse MD||; Stain, Steven C. MD∗∗; DeMatteo, Ronald P. MD; Vickers, Selwyn M. MD††; Britt, L. D. MD, MPH‡‡; Martin, Colin A. MD††

Author Information
doi: 10.1097/SLA.0000000000004151
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Abstract

Information detailing the optimal credentials to successfully rise to the highest ranks of national surgical leadership within organized medicine is severely lacking. There is also historical concern, that leadership attainment is more about who one knows than what one has achieved.

The American College of Surgeons (ACS) and the American Surgical Association (ASA) are arguably the 2 most prestigious professional surgical societies in the country.1,2 Recognizing the shortcomings of sex and ethnic diversity within their leadership and membership, the ACS and the ASA have made strides to partner with organizations such as the Association of Women Surgeons (AWS) and the Society of Black Academic Surgeons (SBAS) in an attempt to promote diversity and inclusion. The AWS and SBAS are relatively young surgical societies that have served as formalized affinity groups to bolster the scientific, scholastic, and professional achievement of individuals who previously have been underrepresented in the surgical workforce relative to the nation's demographics.3,4

Due to a scarce amount of data exploring the metrics one must obtain to rise to a leadership position in any of these prominent surgical societies, members from the ACS, ASA, AWS, and SBAS have partnered to conduct an assessment of the last 16 presidents from each society. The intent of this study is to serve as a first of its kind assessment benchmarking what a surgeon should strive towards if they aspire to become a national leader in American surgery. Additionally, the authors hypothesized that the presidents from the AWS and the SBAS have levels of professional achievement comparable to those that have led the ACS and ASA, providing further evidence that women and ethnically underrepresented in medicine (UIM) surgeons are deserving of additional national leadership opportunities.

METHODS

Data Collection/Extraction

Request for curriculum vitae (CVs) were sent to the last 16 presidents (or families) of the ACS, ASA, AWS, and SBAS. Demographic information inclusive of age, number of years post definitive surgical training, sex, and race/ethnicity, location of and type of medical degree completed, location of their surgical residency training, completion of a formal fellowship and its location, and location of employment at the time of their presidency were all collected. More traditional metrics were also assessed, including additional degree(s) beyond their medical degree and type, faculty rank, number of peer reviewed publications listed on CVs and confirmed in PUBMED, number of first or senior author peer reviewed publications, H-index (web of science), number of textbook chapters, American Board of Medical Specialties (ABMS) board certification status, Fellowship in the American College of Surgeons (FACS), subspecialty fellowship completion, subspecialty field, National institutes of Health (NIH) federal funded research grants awarded, number of invited lectures, department chair appointment, division chief appointment, residency or fellowship program director appointment, number of professional society memberships, previously serving as another surgical society president (local/regional/or national), and elected as a director of the American Board of Surgery (ABS).

Data Analysis

In the analysis, means and standard deviations for these metrics for the 4 societies were assessed separately to determine demographics (age, sex, race, number of years post training), education, faculty appointments and rank, scholastic achievement peer reviewed publications, textbook chapters, invited lectures, and NIH funding. In our preliminary analyses, we noted a significant age discrepancy between AWS and SBAS presidents relative to ASA and ACS presidents. To better compare the groups of presidents accounting for this age discrepancy, CVs of the ASA and ACS presidents were reassessed at the time point corresponding to the combined average age of the AWS and SBAS presidents (52 years old). Using this adjusted data, we conducted our regression analyses.

Using a linear regression model adjusted for age, sex, year of presidency and years post training, the academic contributions of surgical association presidents relative to the ACS were analyzed to determine relative differences in academic achievement across surgical association presidents. Next, linear and logistic regression analyses for role/honors/funding adjusted for age at time of presidency, years in practice after training at time of presidency, sex, and year of presidency was run to determine relative differences in scholastic achievement, appointments and roles across surgical societies. Fisher exact test was used to compare the frequency of roles held by presidents for those cases where low frequencies made regression models unreliable (faculty rank, department chair appointment, ABMS board certification, and FACS.

RESULTS

Full Cohort of the Surgical Societies’ Presidents

We successfully received a total of 62 of the 64 presidents’ CVs from the ACS, ASA, AWS, and SBAS from their respective 2003–04 to 2018–19 presidential terms, equating to a 97% response rate. We found that 100% of the organizations’ presidents were both ABMS board certified and FACS at the time of their presidential terms (Table 1). The collective presidents all completed allopathic medical degrees with these degrees being completed at 43 different medical schools. From the group, 2 of the presidents obtained their degrees outside of the United States (foreign medical graduates). The medical school with the largest representation was Harvard Medical School with 10 of the presidents having received their MD from that institution. Johns Hopkins University School of Medicine had the second most representation with 6 presidents. No other medical school had more than 3.

TABLE 1 - ACS, ASA, AWS, and SBAS Presidents’ Demographics and Education
ACS (n = 16) ASA (n = 15) AWS (n = 15) SBAS (n = 16)
Age in years (SD) 70 (4) 66 (5) 51 (5) 53 (5)
Years post training, mean (SD) 38 (5.6) 34 (5.02) 16 (5.58) 20 (5.06)
Race/ethnicity (%)
 White 13 (81) 13 (87) 15 (100) 0 (0)
 African-American 2 (12) 1 (7) 0 (0) 16 (100)
 Latino 1 (6) 1 (7) 0 (0) 0 (0)
 Asian 0 (0) 0 (0) 0 (0) 0 (0)
 American Indian/Alaskan Native 0 (0) 0 (0) 0 (0) 0 (0)
Sex (%)
 Male 13 (81) 14 (93) 0 (0) 15 (94)
 Female 3 (19) 1 (7) 15 (100) 1 (6)
Degrees/certifications (%)
 PhD 0 (0) 1 (7) 1 (7) 0 (0)
 MBA 0 (0) 0 (0) 2 (13) 3 (19)
 MPH 1 (6) 1 (7) 0 (0) 1 (6)
 Other 2 (12) 3 (20) 1 (7) 1 (6)
 Any degree in addition to medical degree 3 (19) 5 (33) 4 (27) 5 (31)
 Fellow of the American College of Surgeons 16 (100) 15 (100) 15 (100) 16 (100)
 ABMS Board Certification 16 (100) 15 (100) 15 (100) 16 (100)
Sub-specialty Fellowship (%) 11(69) 12(80) 12(80) 15(94)
ABMS indicates American Board of Medical Specialties; ACS, American College of Surgeons; ASA, American Surgical Association; AWS, Association of Women Surgeons; SBAS, Society of Black Academic Surgeons; SD, standard deviation.

The collective presidents received their surgical residency training at 40 different training programs. One of the presidents completed their surgical residency training outside of the United States but completed a fellowship in the United States. The surgical residency training program with the largest representation was Johns Hopkins University with 5. The University of Pennsylvania and Massachusetts General Hospital were tied for second with 4. No other residency training program had more than 3.

Collectively, 81% of the presidents completed a surgical subspecialty fellowship. All traditional surgical specialties were represented among the 62 presidents except for Urology and Orthopedic Surgery. Trauma/Critical Care and Surgical Oncology had the largest representation with 13 each.

At the time of their presidency, all presidents held faculty appointments with representation from 43 different institutions within the United States. The University of Texas Medical Branch and the University of Washington had the largest representation, each with 4 presidents. No other department of surgery had more than 3 presidents.

ACS and ASA Presidents

The data extraction results for the ACS and ASA were very similar with no metric revealing statistical significance between these 2 groups both at the time of their presidency and at age 52, thus their results are reported together. The average age for ACS and ASA presidents were 70 and 66 years old, respectively. The number of years post-surgical training for the ACS and ASA presidents were 38 and 34 years, respectively. The ACS and ASA presidents were predominantly male at 81% and 93%, respectively. The ACS presidents’ racial demographic consisted of 81% White, 12% African-American, 6% Latino, 0% Asian, and 0% American Indian/Alaskan Native. The ASA presidents’ racial demographic consisted of 87% White, 7% African-American, 7% Latino, 0% Asian, and 0% American Indian/Alaskan Native. The ACS and ASA presidents with additional degrees beyond their medical degrees were 19% and 33%, respectively (Table 1).

The ACS and ASA presidents’ average number of peer review publications were 236 and 257, respectively (Table 2). At age 52, the average number of peer review publications for the future ACS and ASA presidents were 122 and 146, respectively (Table 2). Regarding NIH research funding, 62% and 67% of the ACS and ASA presidents respectively, had secured federal funding at some point in their careers. At age 52, 56% and 53% of the future ACS and ASA presidents had secured NIH research funding, respectively. The average H-index for ACS and ASA presidents were 54 and 54, respectively. The H-index could not be calculated at age 52 as this is a relatively new metric that could not be calculated retrospectively.

TABLE 2 - Scholarship, Appointments, and Roles Averages for Presidents of ACS, ASA, AWS, and SBAS
ACS ACS (at age 52) ASA ASA (at age 52) AWS SBAS
Years post training, mean (SD) 38 (5.6) 21 (4) 34 (5) 20 (2.3) 16 (5.6) 20 (5.1)
Academic contribution, mean (SD)
 Total peer review journal publications 237 (134.8) 122 (81.5) 258 (153) 147 (71.7) 39 (33.1) 73 (26.3)
 Journal publications (first or senior author) 132 (73.3) 96 (62) 142 (102.8) 106 (56.1) 16 (8.9) 27 (10.7)
 Textbook chapters 57 (45.8) 27 (21.2) 71 (41.9) 47 (31.8) 8 (5.1) 19 (15.2)
 Invited lectures 163 (149.8) 31 (31.1) 221 (168.01) 40 (30.6) 23 (17.3) 58 (54.8)
 Number of professional society memberships 34 (7.8) 27 (7.5) 35 (10.4) 30 (8.5) 15 (4.9) 23 (6.4)
Roles and appointments, N (%)
 Department chair 14 (88) 6 (38) 14 (93) 9 (60) 0 (0) 9 (56)
 Division chief 14 (88) 11 (69) 13 (87) 11 (73) 5 (33) 14 (88)
 Residency/fellowship program Director 6 (38) 2 (12) 8 (53) 5 (33) 7 (47) 12 (75)
 Prior surgical society president 15 (94) 13 (81) 12 (80) 9 (60) 3 (20) 4 (25)
 Director of the American Board of Surgery 10 (63) 6 (40) 8 (53) 4 (27) 0 (0) 0 (0)
Professorship rank, N (%)
 Associate 0 (0) 0 (0) 0 (0) 0 (0) 12 (80) 2 (12)
 Full 16 (100) 16 (100) 15 (100) 15 (100) 3 (20) 14 (88)
NIH funding, N (%) 10 (62) 9 (56) 10 (67) 8 (53) 4 (27) 9 (56)
Relative to ACS at age 52, using Fisher exact tests revealed a statistically significant difference (P < 0.001).ACS indicates American College of Surgeons; ASA, American Surgical Association; AWS, Association of Women Surgeons; SBAS, Society of Black Academic Surgeons; SD, standard deviation.

The average number of invited lectures for the ACS and ASA presidents were 163 and 220, respectively. At age 52, the average number of invited lectures for the future ACS and ASA presidents were 31 and 40, respectively. The average number of professional society memberships for ACS and ASA presidents were 34 and 35, respectively. At age 52, the average number of professional society memberships for the future ACS and ASA presidents were 27 and 30, respectively. The vast majority of ACS and ASA presidents had previously served as presidents of other surgical societies, 94% and 80% respectively. At age 52, the number of future ACS and ASA presidents that had already served as a president of another surgical society was 81% and 60%, respectively (Table 2).

Pertaining to the professional roles and appointments of ACS presidents, 100% were full professors, 88% had been or were presently serving as a department chair, 88% had been or were serving as a division chief, and 38% had been or were serving as a residency/fellowship program director. At age 52, 100% of these future ACS presidents were full professors, 38% had been or were serving as a department chair, 69% had been or were serving as a division chief, and 12% had been or were serving as a residency/fellowship program director (Table 2).

Pertaining to the professional roles and appointments of ASA presidents, 100% were full professors, 93% had been or were presently serving as a department chair, 87% had been or were serving as a division chief, and 53% had been or were serving as a residency/fellowship program director. At age 52, 100% of these future ACS presidents were full professors, 60% had been or were serving as a department chair, 73% had been or were serving as a division chief, and 33% had been or were serving as a residency/fellowship program director (Table 2).

AWS Presidents

The average age for the AWS presidents was 51 years old. The average number of years postsurgical training for AWS presidents was 16 years. All of the AWS presidents were women, and all were White. Twenty-seven percent (27%) of the AWS presidents had additional degrees beyond their medical degrees (Table 1). The average number of peer reviewed publications for AWS presidents was 39. Regarding NIH research funding, 27% of AWS presidents had secured federal funding at some point in their careers. The average number of invited lectures for AWS presidents was 23. The average number of professional society memberships for AWS presidents was 16, and 20% of them had previously served as president of another surgical society (Table 2).

Pertaining to the professional roles and appointments of AWS presidents, 20% were full professors, 0% had been or were presently serving as a department chair, 33% had been or were serving as a division chief, and 47% had been or were serving as a residency/fellowship program director (Table 2).

SBAS Presidents

The average age for the SBAS presidents was 53 years old. The average number of years postsurgical training for SBAS presidents was 20 years. The SBAS presidents were predominantly male at 94% and all of the SBAS presidents were African-American. Thirty-one percent (31%) of the SBAS presidents had additional degrees beyond their medical degrees (Table 1). The average number of peer reviewed publications for SBAS presidents was 73. Regarding NIH research funding, 56% of SBAS presidents had secured federal funding at some point in their careers. The average number of invited lectures for SBAS presidents was 58. The average number of professional society memberships for SBAS presidents was 23, and 25% of them had previously served as president of another surgical society (Table 2).

Pertaining to the professional roles and appointments of SBAS presidents, 88% were full professors, 56% had been or were presently serving as a department chair, 88% had been or were serving as a division chief, and 75% had been or were serving as a residency/fellowship program director (Table 2).

Linear and Logistical Regression Analysis

Relative to the ACS, there were no statistically significant differences in any of the CV metrics for the ASA presidents. However, the AWS and SBAS had statistically significant lower totals across nearly all metrics relative to the ACS. Age and number of years post training were obvious confounders when comparing the ACS (and ASA) to the AWS and SBAS presidents. The average age of the ACS presidents was 19 and 17 years older than the AWS and SBAS presidents, respectively. Similarly, the average number of years postsurgical training for ACS presidents was 22 and 18 years more than the AWS and SBAS presidents, respectively. This finding meant that the ACS presidents had twice the number of years to accumulate their scholastic pursuits compared to the AWS and SBAS presidents (Table 2).

When performing the regression analysis for the ACS and ASA presidents’ CVs at age 52, there were no statistically significant differences in any of the metrics. Relative to the ACS presidents’ CVs at age 52, the AWS presidents were comparable in 9 of the 15 metrics. AWS presidents had statistically lower values for first or senior author publications, NIH research funding, number of professional society memberships, and previously serving as a surgical society president (P < 0.05) (Table 3). The AWS presidents also had statistically lower likelihood of being a full professor (Table 2) or department chair relative to the ACS cohort at age 52 (Table 3).

TABLE 3 - Linear Regression/Logistic Regression Relative to ACS Presidents at Age 52
ASA AWS SBAS
Adjusted linear regression with corresponding coefficients, confidence intervals and P-values
 Total peer review journal publications 24.63 (−19.31, 68.57) 0.27 −34.74 (−124.9, 55.41) 0.44 −27.2 (−95.1, 40.69) 0.43
 Journal publications (first or senior author) 10 (−20.73, 40.73) 0.52 −80.07 (−110.79, −49.34) <0.001 −69.32 (−99.56, −39.08) <0.001
 Invited lectures 9.14 (−30.17, 48.46) 0.64 −8.12 (−43.1, 26.86) 0.64 26.91 (−9.33, 63.16) 0.14
 Number of professional society memberships 1.93 (−3.43, 7.29) 0.47 −11.68 (−22.69, −0.68) 0.038 −8.53 (−16.85, −0.21) 0.045
 Text book chapters 18.41 (1.87, 34.96) 0.03 4.40 (−29.34, 38.15) 0.79 −5.897 (−32.32, 20.52) 0.66
Adjusted logistic regression with corresponding odds ratios, confidence intervals and P-values
 Department chair 3.59 (0.72, 21.18) 0.13 (P < 0.001) 2.73 (0.22, 41.57) 0.44
 Division chief 1.55 (0.28, 9.70) 0.62 0.32 (0.01, 7.58) 0.49 3.41 (0.22, 56.06) 0.90
 Prior surgical society president 0.40 (0.06, 2.25) 0.31 0.02 (0, 0.61) 0.037 0.03 (0.001, 0.48) 0.021
 NIH funding 0.73 (0.14, 3.69) 0.70 0.01 (0, 0.23) 0.009 0.092 (0.004, 1.19) 0.09
 Sub-specialty fellowship 0.99 (0.12, 8.05) 0.99 0.13 (0.001, 7.88) 0.35 0.18 (0.004, 9.41) 0.37
 Any degree in addition to MD 1.87 (0.22, 20.90) 0.57 0.54 (0.01, 50.73) 0.78 0.40 (0.006, 23.52) 0.65
 Program/residency directory 8.37 (1.11, 176.96) 0.07 2.29 (0.07, 85.43) 0.64 67.38 (3.37, 3008.92) 0.012
Fisher exact test was employed here as the 0 count would not allow a regression to be performed.Three other metrics were assessed. (1) ABMS Board Certification and (2) Fellow of ACS, were 100% for all 4 societies thus could not fit a regression model as there is not difference (Table 1). (3) Full Professor rank comparison also did not fit a regression model and instead a Fisher exact test was performed (Table 2).ACS indicates American College of Surgeons; ASA, American Surgical Association; AWS, Association of Women Surgeons; SBAS, Society of Black Academic Surgeons.

Relative to the ACS presidents’ CVs at age 52, the SBAS presidents’ scholastic achievements were analogous in 12 of the 15 metrics. SBAS presidents had statistically lower values for first or senior author publications, number of professional society memberships, and previously serving as a surgical society president (P < 0.05) (Table 3). SBAS presidents had significantly higher percentage of serving as a residency or fellowship program director than the ACS cohort at age 52 (P = 0.012) (Table 3). Although it did not reach the level of significance, AWS presidents also had a higher percentage of serving as a residency or fellowship program director when compared to ACS presidents.

DISCUSSION

Benchmarking the Achievements of Preeminent Surgical Leaders

Institutionally Agnostic

An encouraging finding of this study is that the apex of leadership in American Surgery has come from a vast number of institutions that span the US. This speaks to the general strength of the country's medical and surgical education system, but also is comforting to know that acumen, hard work, and scholastic achievement can yield professional success, regardless of educational pedigree. The fact that presidents from these 4 prestigious societies received their medical education, surgical training, and faculty appointments from over 40 different institutions, respectively, suggests that leadership opportunities in organized medicine are not restricted exclusively to matriculates from specific medical institutions.

Value of Scholastic Achievement

The level of scholastic and professional achievement of the presidents that have served all 4 of these organizations is nothing short of admirable. Our results revealed an overwhelming consistency in scholastic achievement through peer reviewed publications and textbook chapters if one aims to be considered for elite leadership opportunities in professional surgical societies. This has been described in the literature pertaining to how academic promotion is achieved but this fact also seems to ring true for leadership attainment.5–7 Conducting interdisciplinary and collaborative research is essential and is translatable to the skills needed to lead an academic organization.8–10

Scholastic pursuits can also expand an individual's social and academic network. These networks can allow young aspiring leaders to avoid early pitfalls and focus on opportunities most likely to yield tangible academic success. Warner et al, developed a computational tool to study co-author publications in determining network reach among academic physicians.11 Network reach was calculated in part by assessing the number of first, middle, and senior authors publications. The authors found that among assistant professors, White men had greater network reach compared to women and ethnic minorities.11 This concept may in part explain some of the differences seen in our study.

Comparing AWS and SBAS Presidents to ACS and ASA Presidents

Although not equivalent, the AWS and SBAS presidents’ scholastic achievements were comparable to the ACS and ASA cohort at age 52 in 9 and 12 of the 15 accessed metrics, respectively. When looking more closely at where the AWS and SBAS presidents had lower tallies, peer reviewed publications clearly are a growth opportunity for both cohorts. The historical concern about female academicians not receiving the same rate of promotion as their male counterparts is again obvious.12,13 The fact that only 20% of the AWS presidents held the rank of Full Professor compared to 100% of the primarily male, future ACS and ASA presidents at comparable ages is alarming. This has been a well described challenge for ethnic minority academicians as well, with relatively few UIM (primarily African-American, Latino, and American Indian/Alaskan native) faculty being promoted to Full Professor.14–16 According to the 2018 Association of American Medical Colleges (AAMC) faculty report, women and African-Americans comprise just 12% and 2.5% of US Full Professors of surgery, respectively.17

The lack of female and UIM promotion to Full Professor not only is an equity concern, but it also directly impacts one of the other glaring findings of this study which showed a lack of AWS presidents holding department chair positions. This has recently been explored with some evidence of progress in the last decade,18 but with over half of medical students currently being women,19 we argue that this progress is not occurring rapidly enough. The lack of African-American surgical department chairs is a persistent concern as well, and there is evidence that their representation is declining (Fig. 1). The AAMC recognizes 154 departments of surgery that are based at accredited US allopathic medical schools.20 As of April 2020, 20 (13%) of those departments are chaired by women, up from 3 (2%) in 2008.18,21 Currently 7 (4.5%) of those 154 surgical departments are chaired by African-Americans, and if the 3 historically black universities are excluded (Howard, Meharry, and Morehouse), the percentage of African-American surgical department chairs falls to 2.6%. It should also be mentioned that none of the 154 departments of surgery are chaired by an African-American woman, and as of 2020 an African-American woman has never chaired a department of surgery in our nation's history.18

F1
FIGURE 1:
Percentage of women and African-American Chairs of US Allopathic Medical School Affiliated Departments of Surgery. Data from Association of American Medical Colleges (AAMC) Faculty Roster,20 Association of Women's Surgeons (AWS) website, and the Society of Black Academic Surgeons (SBAS) website.

Both the AWS and SBAS presidents had lower number of professional society memberships and were significantly less likely to have previously been a president when compared to the ACS and ASA cohort even after controlling for age. This again presumably speaks to the historical challenges of exclusivity of women and UIM academicians.22 If the historical gate-keepers are comprised of a rather homogenous group (White males) from a less progressive era, it should not be a surprise that the organizations’ membership and those chosen to lead those organizations lacked sex and ethnic diversity. With recent affiliations between the ACS and ASA and organizations such as the AWS, SBAS, and the Society of Asian American Surgeons (SAAS) among others, the gate seems to be opening for a much more diverse and inclusive group of surgeons.

Moving Forward

Limitations

This study has several limitations. We are not suggesting that the only metrics that determine the ascent of a surgeon to a leadership role are the ones that we assessed. We chose objective information that was consistently recorded by the presidents on their CVs. Information such as abstracts, nonfederal research funding, journal reviewer, and other scholastic pursuits would have been excellent to include but were not universally documented on all CVs. Although election as a director of the ABS was extracted (Table 2), we chose to not include that as a comparable metric between the societies as both the ACS and ASA have dedicated seats on the ABS, and the AWS and SBAS currently do not. We recognize that there is a national registry of surgical chairs organized as the Society of Surgical Chairs that meets annually at the ACS Clinical Congress. This organization recognizes 187 surgery department chairs.23 However, in this study we decided to use only departments of surgery that are based at US allopathic medical schools accredited by the AAMC (154).20 Our reasoning is that we believe that these departmental chairs have further reach into the academic pipeline as their departments are primarily responsible for medical student surgical education.

We are also not suggesting that these metrics are a barometer of leadership effectiveness, but rather leadership attainment. We used the age 52 years old to better compare our surgical society presidents as it was the combined average of the AWS (51) and SBAS (53) presidents. This means that the AWS presidents were presumably disadvantaged by being 1 year younger and the SBAS presidents presumably benefitted by being 1 year older. The Society of Asian Academic Surgeons (SAAS) and the Latino Surgical Society were not included in the study as both organizations are less than 5 years into their existence and we thought it would be most appropriate to assess a longer duration of time.

Growth Areas for AWS and SBAS

This study could be helpful in sponsoring, mentoring, and informing AWS and SBAS members of opportunities for growth when it comes to ensuring that their CVs are competitive for national surgical leadership consideration. Emphasizing the importance of scholastic productivity namely through journal publications and research funding seem prudent. Additionally, achieving higher success in pursuing professional society memberships and leadership opportunities therein seem to be an effective strategy for becoming perceived and recognized as a national leader. Extending ones’ network and exposure is of value and may also lead to additional research collaborations. It is no secret that many of these metrics build on each other. Increased research publications lead to greater likelihood of obtaining research funding. The combination of those 2, historically have paved the way to promotion (for most), and that positions individuals for chief and chair consideration. As evident from this study, those institutional appointments seem useful in obtaining consideration for national leadership nominations. Ironically, it is notable that the Program Director role was traditionally considered to be a stepping-stone for ascent to chair of surgery, but that pipeline role did not seem to be a significant indicator of success for ascent to ACS or ASA Presidency. As such more work needs to be done to better understand the potential work effort effect of this role, if any, on the academic productivity and future success of SBAS and AWS leaders.

In the spirit of diversity and inclusion, the AWS and SBAS should also be mindful of the demographics of their leadership. During the 16-year span of this study, neither an African-American nor Latino presided over the AWS and only 1 woman served as president of SBAS. Although both organizations openly invite surgeons of all sex and ethnic backgrounds to join their membership, ensuring leadership opportunities in a more holistically inclusive way serves as an opportunity for growth as well.

Growth Areas for ACS, ASA, and Organized Medicine

Of the combined 32 ASA and ACS presidents captured in this study, there were 4 female presidents and 3 UIM presidents (2 of the 3 UIM presidents presided over both societies). As previously discussed, this study points to persistent institutional challenges with promotion and leadership appointments of women and ethnically UIM physicians in academic medicine. Strategies have been suggested,24–26 but modest action has taken place. This undeniably manifests into lack of consideration of individuals from these demographics for national leadership opportunities. We encourage an invigorated emphasis on intentional and active leadership training of women and UIM surgeons at both the institutional level and within all national surgical societies as a potential solution to closing the gap in these historically lauded credentials and networks.

The numerous benefits of a more diverse cohort of leaders has borne out in the business sector,27,28 and medicine now has the opportunity to follow suit. As we look to imminent leaders in American surgery, the AWS and SBAS have competitive leaders among their ranks particularly as they bolster their publishing and networking efforts. These 2 organizations in addition to the newly formed SAAS and Latino Surgical Society, clearly can serve as fertile ground for future recruitment of a more diverse group of leaders into the previously established national surgical society ranks. Where academic and professional merit has not proven to guarantee leadership opportunities for all, organized medicine is now positioned (and armed with evidence) that a more diverse and inclusive cohort of leaders can advance the field, the education of future providers, and the health of the nation.

Acknowledgments

The authors would like to send our sincerest condolences to the families and loved ones of 4 of the national surgical society presidents that are no longer with us. Drs. Jay L. Grosfeld, Claude H. Organ, Jr., Donald D. Trunkey, and William L. Weaver were talented physicians that made tremendous contributions to the field. We thank their families for their graciousness in sending us their CVs to ensure that their legacies endure, and all 4 are sorely missed.

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Keywords:

benchmarking achievement; diversity and inclusion; leadership attainment; surgical leadership

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