CHAPTER 13
The Future of The Society of Thoracic Surgeons Douglas E. Wood, MD Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
he Society of Thoracic Surgeons (STS) was “born of a revolution,” a desire by the founders and early leaders to provide a specialty society that was inclusive, rather than exclusive, and one that would provide a scientific and clinical “home” dedicated to the rapidly expanding field of cardiothoracic surgery. The founders described their goals as the following: “(1) to disseminate information on thoracic and cardiovascular surgery; (2) to promote thoracic and cardiovascular surgery as a specialty; and (3) to offer a forum for young men to present and publish papers in the field” [1]. These goals are prescient and appropriately set the framework for the current STS mission “to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.” In his 1972 Presidential Address, Robert G. Ellison, MD declared, “The reasons for the outstanding success of the Society can be summarized in two words: need and leadership” [1]. Indeed, STS has been successful by virtually any measure. STS is now the largest cardiothoracic surgery society in the world, representing more than 6,800 members from 85 countries. The Society provides a wide range of educational programs for surgeons and their teams, pioneering one of the most important specialty clinical databases in the world, and consistently influencing United States health care policy on behalf of patients with thoracic and cardiovascular disease. Yet, the most enduring and important measure of success is the role that STS has had in improving the breadth and quality of care that cardiothoracic surgeons provide for their patients. It is a daunting task to consider or predict the future of cardiothoracic surgery and, by extension, The Society of Thoracic Surgeons. In such a rapidly changing environment of both health care policy and advancing technology, it is hard to anticipate the next 5 years, much less the next 50. Many view the glory days of cardiothoracic surgery to be in the past, with declining interest in the specialty and a crisis of a narrowed scope of practice and infringement by other specialties. However, another view sees a dynamic specialty that is growing, evolving, and developing in relation to advancing technologies, changing demographics, and new opportunities for collaboration across medical specialties [2]. STS is at the center of these crossroads with the surgeon leadership (see Fig 1 for STS Board of Directors 2013–2014) and staff (Fig 2) focused on influencing the evolution of cardiothoracic surgery, empowering a strong constituency of surgeons
T
Address correspondence to Dr Wood, 1959 NE Pacific, Rm AA-115, Box 356310, Seattle, WA 98195-6310; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
and their teams to partner with other specialties in order to provide the best outcomes for patients with cardiothoracic disease. With a view toward the future, STS will continue to be the “home” of cardiothoracic surgery in the US, maintaining an emphasis on educating practicing surgeons and expanding their scope of practice as technology evolves, influencing and advocating for cardiothoracic surgeons and their patients with government, payers, industry, and policymakers, and developing an ever-increasing research infrastructure for the advancement of the field and the dissemination of optimal and evidence-based practice.
STS National Database The STS National Database and its three component databases, the Adult Cardiac Surgery Database, the Congenital Heart Surgery Database, and the General Thoracic Surgery Database, are now an incredible asset for cardiothoracic surgeons, and a resource for evaluating and improving patient results and impacting health care policy. The databases fulfill each of the 3 initiatives expounded in the STS mission; education, research, and advocacy. Education occurs in both the feedback of clinical outcomes benchmarked to national standards, as well as the publications emanating from database analysis. The upcoming years will see the databases continue to be an engine for surgical outcomes and comparative effectiveness research, and likewise serve as a foundation for partnership and policy influence with the Centers for Medicare & Medicaid Services (CMS) and others. An STS Database Think Tank in 2013, led by the volunteer leaders and professional staff in the STS Council for Quality, Research and Patient Safety, is setting the stage for the future innovation and utility of our databases so that they evolve to be even more nimble, accessible, transparent, and beneficial (eg, by linking with other data systems to provide longitudinal data). Representing the globalization of cardiothoracic surgery, STS has begun to add important international sites that will expand the relevance and scope of our clinical databases beyond the US. The strength of the databases will continue to be augmented and leveraged by partnership and linkage with other data systems, an important recent example being publication of results from the ASCERT Trial, utilizing data from STS, the American College of Cardiology’s National Cardiovascular Data Registry, and CMS, that evaluated the comparative effectiveness of coronary artery bypass grafting and percutaneous coronary interventions. It is expected that the STS databases will increasingly leverage similar partnerships with allied specialties and Ann Thorac Surg 2014;97:S58–S62 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.10.010
Ann Thorac Surg 2014;97:S58–S62
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Fig 1. STS Board of Directors 2013–2014: (front row) Keith S. Naunheim, MD, David A. Fullerton, MD, Douglas E. Wood, MD, Jeffrey B. Rich, MD, Mark S. Allen, MD, and Robert S.D. Higgins, MD; (back row) John H. Calhoon, MD, David R. Jones, MD, Emile Bacha, MD, Christopher A. Calderone, MD, Joseph F. Sabik, III, MD, and Nicholas T. Kouchoukos, MD. Not pictured: Joseph E. Bavaria, MD, L. Henry Edmunds, Jr, MD, Friedrich W. Mohr, MD, Cameron T. Stock, MD, Shinichi Takamoto, MD, and Cameron D. Wright, MD.
administrative databases, as well as international cardiothoracic databases (eg, those of the European Association for Cardio-Thoracic Surgery [EACTS] and the European Society of Thoracic Surgeons [ESTS]) to further research in surgical outcomes and constantly improve our care for patients.
Education Educating practicing surgeons has been at the core of the STS mission since the Society’s founding, and the field of graduate and postgraduate education is evolving perhaps even more quickly than the field of cardiothoracic surgery. The labor intensive and slow acquisition of new information through textbooks and print journals is rapidly being supplanted by “just-in-time” learning powered by internet search engines and ubiquitous and pervasive videos of surgical techniques. Peer-reviewed research is still important but is increasingly accessed in real time and with a desire by students, residents, and practicing surgeons to be collated, summarized, and compared so that guidelines or bullet points can speed the application of new knowledge. To meet this education imperative, STS has a team of education professionals on its Council on Education and Member Services with the goal of revolutionizing and improving the way new technology and cutting-edge research is delivered to practicing cardiothoracic surgeons. Standalone courses in techniques and the STS University portion of the Annual Meeting provide surgeons with the tools and experience they need to adapt to changing technology. Electronic learning (e-learning) allows surgeon experts to partner with education professionals to leverage the internet and provide a broad and effective reach of STS education programs, which is especially relevant to the new generation of cardiothoracic surgeons. Clinical guidelines
provide practicing surgeons with the best evidence-based and amalgamated tools for informing and improving their practices. These guidelines have long been a mainstay of STS education and in the future will only be more important for surgeon education and clinical standards to improve patient care. Fortunately we have the broad expertise and experience of the surgeons on the Workforce for Evidence Based Surgery to lead and guide this effort that is so important for future advances in cardiothoracic surgery.
Collaborations Over the past several years STS has increasingly initiated partnerships with other specialty societies in order to better achieve a common interest, be it in physician education or in helping to direct responsible health care policy. This will certainly continue and expand in the coming years with better opportunities for advancement of the specialty leveraged by synergistic and strategic collaboration with others rather than working in isolation. These partnerships can be described in three different, but complementary ways: alliance with other cardiothoracic specialty societies, cooperation with allied specialties, and closer association with US cardiothoracic surgical organizations through shared resources and management. The most obvious and closest partner for STS throughout our history has been the American Association for Thoracic Surgery (AATS). The relationship of STS and AATS continues to be one of the most important and meaningful, resulting in combined educational courses at both societies’ annual meetings and joint workforces in new technology and health care policy. In addition, STS has forged a significant and warm relationship with EACTS through a closely shared mission and culture. EACTS represents the cardiothoracic specialty in Europe
S60
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WOOD
Ann Thorac Surg 2014;97:S58–S62
Fig 2. STS Staff 2013. (A) Headquarters, Chicago, IL: (front row) Angel L. Law, Carrie A. Ryan, Rachel P. Pebworth, Lisa Quintana, Arelia Garcia, Rachel L. Black, Rebecca J. Mark, Heather Watkins, Priscilla S. Kennedy and Deborah Watrous; (second row) Natalie Boden, Sylvia L. Novick, W. Grahame Rush, Robert A. Wynbrandt, DeLaine Schmitz, Courtney Miller Donovan, Cynthia M. Shewan, and Damon K. Marquis; (back row) Armando Juarez, Michele Chao, Karen Graham, Jessica Jones Thorne, Megan Wright Drumm, Donna McDonald, Michael Skallas, Bianca Reyes, Kristin M. Ayers, Ellen R. Clough, Hilary M. Kirk, Samantha McCarthy, Jane M. Han, Sikirat A. Tijani, Sarah Foreman, Gerard Tarafa, Amy C. Dancisak, Cheryl D. Wilson, Theresa M. Lopez, Scott M. Firestone, Sharon U. Zmucki, Darcy E. Sengewald, Kelley Oates, George P. Bohn, and Jaclynne D. Madden. Not pictured: Jazmine Blanch, Emily Conrad, Cassie McNulty, Lindsey Meyer, Fred H. Edwards, MD, Tina Kourtis, Erin Luytjes, Emily Massa, Laura Medek, Jogesh Sehdev, William F. Seward, Shilpa Srikakolapu, and Beth Winer. (B) Government Relations, Washington, DC: Josh Krantz, Phillip A. Bongiorno, and Courtney Yohe; (inset) STS Coding and Billing, Denver, CO: Julie R. Painter; and (C) The Annals Editorial Office, Philadelphia, PA: (front row) Heide M. Pusztay and L. Henry Edmunds, Jr, MD; (back row) Stacey Kauffman, Cassie A. Kosarek, Amy Bluemle, Cindy A. Davidson, and Steven M. Wilson.
just as STS does in North America, and each organization shares overlapping yet complementary international scope beyond its primary continent. Together the organizations have forged reciprocal agreements relating to membership application and work together in educational programs for cardiothoracic surgeons worldwide. ESTS is the largest and most important organization of general thoracic surgeons in the world, and also has become a close partner with STS. Sharing a similar name, STS and ESTS also have developed a reciprocal membership
application relationship and common educational efforts dedicated to the practicing general thoracic surgeon. STS sees these partnerships with sister societies as paramount to the success of the specialty worldwide and will continue to be motivated to expand these shared initiatives. The future will certainly involve increasing the scope of these relationships with other cardiothoracic surgical organizations worldwide, already including the Asian Society for Cardiovascular and Thoracic Surgery and looking toward similar partnerships with
Ann Thorac Surg 2014;97:S58–S62
organizations in Asia, South America, Africa, and Australia, enhancing the Society’s relevance and value to cardiothoracic surgeons outside of North America. Although partnerships between STS and other cardiothoracic surgical organizations have been an important part of the globalization of the specialty, collaboration with allied specialties is becoming an ever more important aspect of STS relations as cardiothoracic surgeons increasingly work in teams. Cardiovascular surgeons now frequently are joined with their cardiology colleagues as “heart teams,” developed to optimize multidisciplinary decision making and hybrid approaches in coronary artery disease, structural heart disease, end-stage heart disease, and vascular pathology. General thoracic surgeons are nearly always part of a multidisciplinary thoracic oncology team, and congenital cardiac surgeons are closely partnered with pediatric cardiology, anesthesia, and critical care. Reflecting this teamwork in cardiothoracic surgery, STS has developed a close and increasingly important relationship with the ACC, together most notably developing criteria to support a National Coverage Determination for transcatheter aortic valve replacement and the critical STS/ACC Transcatheter Valve Therapy Registry. The STS and ACC collaboration ushers in a new era of specialty society leadership in the evaluation and implementation of new technology and offers, to government, industry, payers, and policy makers, a new paradigm for technology assessment, including specialty society sponsorship of Food and Drug Administration Investigational Device Exemptions to evaluate the safety and efficacy of new devices and indications. Partnership with allied specialties will continue to be an STS priority in areas of physician education. As new procedures and technologies develop, cardiothoracic surgeons need experience and training so that their practice can keep up to date with expanding procedures. An example in general thoracic surgery is the development of navigational bronchoscopy and endobronchial ultrasound for the diagnosis and staging of lung cancer. The STS has teamed up with the American College of Chest Physicians and developed both annual meeting and standalone programming to provide thoracic surgeons with the training that they need to introduce these procedures into their daily practice. The Society will continue to explore and expand these partnerships with other specialties to educate surgeons and cardiothoracic teams and to develop synergy and collaboration between specialties with common goals in patient outcomes.
Research Research is intimately intertwined with education because without research, knowledge and training does not flourish or generate new ideas. STS has long been invested and engaged in research, from the founding of the Thoracic Surgery Foundation for Research and Education (TSFRE; originally the STS Education and Research Foundation) to the recent creation of the STS Research Center. As already noted, STS databases are a rich source
STS 50TH ANNIVERSARY WOOD FUTURE OF STS
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of raw material to further clinical and comparative effectiveness research. But beyond the databases, STS envisions training new surgeon scientists within the STS Research Center; individuals with the knowledge and skill obtained from dedicated training in health services research who will be leaders in our specialty, defining optimal standards in clinical patient care. STS also plans to engage the Research Center in the application, funding, and implementation of grants related to furthering the specialty. Partnerships that already exist between STS and CMS, the FDA, and the National Institutes of Health are expected to mature as the Society collaborates with the agencies on the evaluation and introduction of new procedures and technologies.
Alliance of US Cardiothoracic Organizations The STS offices in Chicago have become “the house of cardiothoracic surgery” in the US as they have become the headquarters for the following seven other cardiothoracic surgical organizations: the American Board of Thoracic Surgery; CTSNet; the Joint Council on Thoracic Surgery Education; the Southern Thoracic Surgical Association; the Thoracic Surgery Directors Association; TSFRE; and Women in Thoracic Surgery, the latter six managed by the STS. Some have expressed concern that this consolidation of headquarters and management creates an unhealthy hegemony of the STS influence in US cardiothoracic surgery. However, most recognize the substantial benefits conferred by coordination, collaboration, and synergy of efforts by organizations with parallel and comparable goals of supporting cardiothoracic surgeons and their patients. In fact, this alliance results in an efficiency of management, interaction, and harmonization with no loss of individual societal autonomy. Each organization has maintained its own Board and leadership group who have the authority to act independently and in the best interest of each respective entity. Yet, proximity benefits the group through facilitated communication and shared resources that allow a high level of specialized staff that no organization could employ or optimize independently. STS was conceived as an inclusive specialty society, and the vast majority of US cardiothoracic surgeons are now STS members, resulting in an organization that most completely represents the interests of both practicing and academic surgeons in the US. This provides the ideal substrate for the coordination that now occurs with more narrowly focused organizations; ie, those representing US regions, education, research, etc. STS has served as a catalyst and foundation for this amalgamation of specialty organizations, and the future should reveal only more benefits of this healthy and cohesive coordination of US cardiothoracic surgery.
The Future The Society of Thoracic Surgeons is embarking on her second 50 years at an exciting time in the evolution and expansion of cardiothoracic surgery. “Born of a revolution,” STS provides a safe and inclusive “home” for
S62
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WOOD
cardiothoracic surgery in North America and a collaborative partner for cardiothoracic surgeons and their teams around the globe. STS will stay committed to her mission “to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.” Education will flourish under the new paradigm of synthesizing and providing what is needed, when it is needed. Research will support and inform the educational mission and provide the substrate to keep the specialty fresh and innovative. And STS will partner and collaborate with other specialty societies, government, industry, payers, and policy makers
Ann Thorac Surg 2014;97:S58–S62
to keep cardiothoracic surgery at the forefront of patientcentered care, with a focus on education, research, and advocacy that achieves what is our holy grail, the best possible treatments and outcomes for patients with cardiothoracic disease.
References 1. Ellison RG. Significant events in the history of The Society of Thoracic Surgeons. Ann Thorac Surg 1972;14:577–604. 2. Wood DE. The future of cardiothoracic surgery: a view from North America. Eur J Cardiothorac Surg 2013;43:241–3.
The Future of The Society of Thoracic Surgeons Douglas E. Wood, MD Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
he Society of Thoracic Surgeons (STS) was “born of a revolution,” a desire by the founders and early leaders to provide a specialty society that was inclusive, rather than exclusive, and one that would provide a scientific and clinical “home” dedicated to the rapidly expanding field of cardiothoracic surgery. The founders described their goals as the following: “(1) to disseminate information on thoracic and cardiovascular surgery; (2) to promote thoracic and cardiovascular surgery as a specialty; and (3) to offer a forum for young men to present and publish papers in the field” [1]. These goals are prescient and appropriately set the framework for the current STS mission “to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.” In his 1972 Presidential Address, Robert G. Ellison, MD declared, “The reasons for the outstanding success of the Society can be summarized in two words: need and leadership” [1]. Indeed, STS has been successful by virtually any measure. STS is now the largest cardiothoracic surgery society in the world, representing more than 6,800 members from 85 countries. The Society provides a wide range of educational programs for surgeons and their teams, pioneering one of the most important specialty clinical databases in the world, and consistently influencing United States health care policy on behalf of patients with thoracic and cardiovascular disease. Yet, the most enduring and important measure of success is the role that STS has had in improving the breadth and quality of care that cardiothoracic surgeons provide for their patients. It is a daunting task to consider or predict the future of cardiothoracic surgery and, by extension, The Society of Thoracic Surgeons. In such a rapidly changing environment of both health care policy and advancing technology, it is hard to anticipate the next 5 years, much less the next 50. Many view the glory days of cardiothoracic surgery to be in the past, with declining interest in the specialty and a crisis of a narrowed scope of practice and infringement by other specialties. However, another view sees a dynamic specialty that is growing, evolving, and developing in relation to advancing technologies, changing demographics, and new opportunities for collaboration across medical specialties [2]. STS is at the center of these crossroads with the surgeon leadership (see Fig 1 for STS Board of Directors 2013–2014) and staff (Fig 2) focused on influencing the evolution of cardiothoracic surgery, empowering a strong constituency of surgeons
T
Address correspondence to Dr Wood, 1959 NE Pacific, Rm AA-115, Box 356310, Seattle, WA 98195-6310; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
and their teams to partner with other specialties in order to provide the best outcomes for patients with cardiothoracic disease. With a view toward the future, STS will continue to be the “home” of cardiothoracic surgery in the US, maintaining an emphasis on educating practicing surgeons and expanding their scope of practice as technology evolves, influencing and advocating for cardiothoracic surgeons and their patients with government, payers, industry, and policymakers, and developing an ever-increasing research infrastructure for the advancement of the field and the dissemination of optimal and evidence-based practice.
STS National Database The STS National Database and its three component databases, the Adult Cardiac Surgery Database, the Congenital Heart Surgery Database, and the General Thoracic Surgery Database, are now an incredible asset for cardiothoracic surgeons, and a resource for evaluating and improving patient results and impacting health care policy. The databases fulfill each of the 3 initiatives expounded in the STS mission; education, research, and advocacy. Education occurs in both the feedback of clinical outcomes benchmarked to national standards, as well as the publications emanating from database analysis. The upcoming years will see the databases continue to be an engine for surgical outcomes and comparative effectiveness research, and likewise serve as a foundation for partnership and policy influence with the Centers for Medicare & Medicaid Services (CMS) and others. An STS Database Think Tank in 2013, led by the volunteer leaders and professional staff in the STS Council for Quality, Research and Patient Safety, is setting the stage for the future innovation and utility of our databases so that they evolve to be even more nimble, accessible, transparent, and beneficial (eg, by linking with other data systems to provide longitudinal data). Representing the globalization of cardiothoracic surgery, STS has begun to add important international sites that will expand the relevance and scope of our clinical databases beyond the US. The strength of the databases will continue to be augmented and leveraged by partnership and linkage with other data systems, an important recent example being publication of results from the ASCERT Trial, utilizing data from STS, the American College of Cardiology’s National Cardiovascular Data Registry, and CMS, that evaluated the comparative effectiveness of coronary artery bypass grafting and percutaneous coronary interventions. It is expected that the STS databases will increasingly leverage similar partnerships with allied specialties and Ann Thorac Surg 2014;97:S58–S62 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.10.010
Ann Thorac Surg 2014;97:S58–S62
STS 50TH ANNIVERSARY WOOD FUTURE OF STS
S59
Fig 1. STS Board of Directors 2013–2014: (front row) Keith S. Naunheim, MD, David A. Fullerton, MD, Douglas E. Wood, MD, Jeffrey B. Rich, MD, Mark S. Allen, MD, and Robert S.D. Higgins, MD; (back row) John H. Calhoon, MD, David R. Jones, MD, Emile Bacha, MD, Christopher A. Calderone, MD, Joseph F. Sabik, III, MD, and Nicholas T. Kouchoukos, MD. Not pictured: Joseph E. Bavaria, MD, L. Henry Edmunds, Jr, MD, Friedrich W. Mohr, MD, Cameron T. Stock, MD, Shinichi Takamoto, MD, and Cameron D. Wright, MD.
administrative databases, as well as international cardiothoracic databases (eg, those of the European Association for Cardio-Thoracic Surgery [EACTS] and the European Society of Thoracic Surgeons [ESTS]) to further research in surgical outcomes and constantly improve our care for patients.
Education Educating practicing surgeons has been at the core of the STS mission since the Society’s founding, and the field of graduate and postgraduate education is evolving perhaps even more quickly than the field of cardiothoracic surgery. The labor intensive and slow acquisition of new information through textbooks and print journals is rapidly being supplanted by “just-in-time” learning powered by internet search engines and ubiquitous and pervasive videos of surgical techniques. Peer-reviewed research is still important but is increasingly accessed in real time and with a desire by students, residents, and practicing surgeons to be collated, summarized, and compared so that guidelines or bullet points can speed the application of new knowledge. To meet this education imperative, STS has a team of education professionals on its Council on Education and Member Services with the goal of revolutionizing and improving the way new technology and cutting-edge research is delivered to practicing cardiothoracic surgeons. Standalone courses in techniques and the STS University portion of the Annual Meeting provide surgeons with the tools and experience they need to adapt to changing technology. Electronic learning (e-learning) allows surgeon experts to partner with education professionals to leverage the internet and provide a broad and effective reach of STS education programs, which is especially relevant to the new generation of cardiothoracic surgeons. Clinical guidelines
provide practicing surgeons with the best evidence-based and amalgamated tools for informing and improving their practices. These guidelines have long been a mainstay of STS education and in the future will only be more important for surgeon education and clinical standards to improve patient care. Fortunately we have the broad expertise and experience of the surgeons on the Workforce for Evidence Based Surgery to lead and guide this effort that is so important for future advances in cardiothoracic surgery.
Collaborations Over the past several years STS has increasingly initiated partnerships with other specialty societies in order to better achieve a common interest, be it in physician education or in helping to direct responsible health care policy. This will certainly continue and expand in the coming years with better opportunities for advancement of the specialty leveraged by synergistic and strategic collaboration with others rather than working in isolation. These partnerships can be described in three different, but complementary ways: alliance with other cardiothoracic specialty societies, cooperation with allied specialties, and closer association with US cardiothoracic surgical organizations through shared resources and management. The most obvious and closest partner for STS throughout our history has been the American Association for Thoracic Surgery (AATS). The relationship of STS and AATS continues to be one of the most important and meaningful, resulting in combined educational courses at both societies’ annual meetings and joint workforces in new technology and health care policy. In addition, STS has forged a significant and warm relationship with EACTS through a closely shared mission and culture. EACTS represents the cardiothoracic specialty in Europe
S60
STS 50TH ANNIVERSARY FUTURE OF STS
WOOD
Ann Thorac Surg 2014;97:S58–S62
Fig 2. STS Staff 2013. (A) Headquarters, Chicago, IL: (front row) Angel L. Law, Carrie A. Ryan, Rachel P. Pebworth, Lisa Quintana, Arelia Garcia, Rachel L. Black, Rebecca J. Mark, Heather Watkins, Priscilla S. Kennedy and Deborah Watrous; (second row) Natalie Boden, Sylvia L. Novick, W. Grahame Rush, Robert A. Wynbrandt, DeLaine Schmitz, Courtney Miller Donovan, Cynthia M. Shewan, and Damon K. Marquis; (back row) Armando Juarez, Michele Chao, Karen Graham, Jessica Jones Thorne, Megan Wright Drumm, Donna McDonald, Michael Skallas, Bianca Reyes, Kristin M. Ayers, Ellen R. Clough, Hilary M. Kirk, Samantha McCarthy, Jane M. Han, Sikirat A. Tijani, Sarah Foreman, Gerard Tarafa, Amy C. Dancisak, Cheryl D. Wilson, Theresa M. Lopez, Scott M. Firestone, Sharon U. Zmucki, Darcy E. Sengewald, Kelley Oates, George P. Bohn, and Jaclynne D. Madden. Not pictured: Jazmine Blanch, Emily Conrad, Cassie McNulty, Lindsey Meyer, Fred H. Edwards, MD, Tina Kourtis, Erin Luytjes, Emily Massa, Laura Medek, Jogesh Sehdev, William F. Seward, Shilpa Srikakolapu, and Beth Winer. (B) Government Relations, Washington, DC: Josh Krantz, Phillip A. Bongiorno, and Courtney Yohe; (inset) STS Coding and Billing, Denver, CO: Julie R. Painter; and (C) The Annals Editorial Office, Philadelphia, PA: (front row) Heide M. Pusztay and L. Henry Edmunds, Jr, MD; (back row) Stacey Kauffman, Cassie A. Kosarek, Amy Bluemle, Cindy A. Davidson, and Steven M. Wilson.
just as STS does in North America, and each organization shares overlapping yet complementary international scope beyond its primary continent. Together the organizations have forged reciprocal agreements relating to membership application and work together in educational programs for cardiothoracic surgeons worldwide. ESTS is the largest and most important organization of general thoracic surgeons in the world, and also has become a close partner with STS. Sharing a similar name, STS and ESTS also have developed a reciprocal membership
application relationship and common educational efforts dedicated to the practicing general thoracic surgeon. STS sees these partnerships with sister societies as paramount to the success of the specialty worldwide and will continue to be motivated to expand these shared initiatives. The future will certainly involve increasing the scope of these relationships with other cardiothoracic surgical organizations worldwide, already including the Asian Society for Cardiovascular and Thoracic Surgery and looking toward similar partnerships with
Ann Thorac Surg 2014;97:S58–S62
organizations in Asia, South America, Africa, and Australia, enhancing the Society’s relevance and value to cardiothoracic surgeons outside of North America. Although partnerships between STS and other cardiothoracic surgical organizations have been an important part of the globalization of the specialty, collaboration with allied specialties is becoming an ever more important aspect of STS relations as cardiothoracic surgeons increasingly work in teams. Cardiovascular surgeons now frequently are joined with their cardiology colleagues as “heart teams,” developed to optimize multidisciplinary decision making and hybrid approaches in coronary artery disease, structural heart disease, end-stage heart disease, and vascular pathology. General thoracic surgeons are nearly always part of a multidisciplinary thoracic oncology team, and congenital cardiac surgeons are closely partnered with pediatric cardiology, anesthesia, and critical care. Reflecting this teamwork in cardiothoracic surgery, STS has developed a close and increasingly important relationship with the ACC, together most notably developing criteria to support a National Coverage Determination for transcatheter aortic valve replacement and the critical STS/ACC Transcatheter Valve Therapy Registry. The STS and ACC collaboration ushers in a new era of specialty society leadership in the evaluation and implementation of new technology and offers, to government, industry, payers, and policy makers, a new paradigm for technology assessment, including specialty society sponsorship of Food and Drug Administration Investigational Device Exemptions to evaluate the safety and efficacy of new devices and indications. Partnership with allied specialties will continue to be an STS priority in areas of physician education. As new procedures and technologies develop, cardiothoracic surgeons need experience and training so that their practice can keep up to date with expanding procedures. An example in general thoracic surgery is the development of navigational bronchoscopy and endobronchial ultrasound for the diagnosis and staging of lung cancer. The STS has teamed up with the American College of Chest Physicians and developed both annual meeting and standalone programming to provide thoracic surgeons with the training that they need to introduce these procedures into their daily practice. The Society will continue to explore and expand these partnerships with other specialties to educate surgeons and cardiothoracic teams and to develop synergy and collaboration between specialties with common goals in patient outcomes.
Research Research is intimately intertwined with education because without research, knowledge and training does not flourish or generate new ideas. STS has long been invested and engaged in research, from the founding of the Thoracic Surgery Foundation for Research and Education (TSFRE; originally the STS Education and Research Foundation) to the recent creation of the STS Research Center. As already noted, STS databases are a rich source
STS 50TH ANNIVERSARY WOOD FUTURE OF STS
S61
of raw material to further clinical and comparative effectiveness research. But beyond the databases, STS envisions training new surgeon scientists within the STS Research Center; individuals with the knowledge and skill obtained from dedicated training in health services research who will be leaders in our specialty, defining optimal standards in clinical patient care. STS also plans to engage the Research Center in the application, funding, and implementation of grants related to furthering the specialty. Partnerships that already exist between STS and CMS, the FDA, and the National Institutes of Health are expected to mature as the Society collaborates with the agencies on the evaluation and introduction of new procedures and technologies.
Alliance of US Cardiothoracic Organizations The STS offices in Chicago have become “the house of cardiothoracic surgery” in the US as they have become the headquarters for the following seven other cardiothoracic surgical organizations: the American Board of Thoracic Surgery; CTSNet; the Joint Council on Thoracic Surgery Education; the Southern Thoracic Surgical Association; the Thoracic Surgery Directors Association; TSFRE; and Women in Thoracic Surgery, the latter six managed by the STS. Some have expressed concern that this consolidation of headquarters and management creates an unhealthy hegemony of the STS influence in US cardiothoracic surgery. However, most recognize the substantial benefits conferred by coordination, collaboration, and synergy of efforts by organizations with parallel and comparable goals of supporting cardiothoracic surgeons and their patients. In fact, this alliance results in an efficiency of management, interaction, and harmonization with no loss of individual societal autonomy. Each organization has maintained its own Board and leadership group who have the authority to act independently and in the best interest of each respective entity. Yet, proximity benefits the group through facilitated communication and shared resources that allow a high level of specialized staff that no organization could employ or optimize independently. STS was conceived as an inclusive specialty society, and the vast majority of US cardiothoracic surgeons are now STS members, resulting in an organization that most completely represents the interests of both practicing and academic surgeons in the US. This provides the ideal substrate for the coordination that now occurs with more narrowly focused organizations; ie, those representing US regions, education, research, etc. STS has served as a catalyst and foundation for this amalgamation of specialty organizations, and the future should reveal only more benefits of this healthy and cohesive coordination of US cardiothoracic surgery.
The Future The Society of Thoracic Surgeons is embarking on her second 50 years at an exciting time in the evolution and expansion of cardiothoracic surgery. “Born of a revolution,” STS provides a safe and inclusive “home” for
S62
STS 50TH ANNIVERSARY FUTURE OF STS
WOOD
cardiothoracic surgery in North America and a collaborative partner for cardiothoracic surgeons and their teams around the globe. STS will stay committed to her mission “to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.” Education will flourish under the new paradigm of synthesizing and providing what is needed, when it is needed. Research will support and inform the educational mission and provide the substrate to keep the specialty fresh and innovative. And STS will partner and collaborate with other specialty societies, government, industry, payers, and policy makers
Ann Thorac Surg 2014;97:S58–S62
to keep cardiothoracic surgery at the forefront of patientcentered care, with a focus on education, research, and advocacy that achieves what is our holy grail, the best possible treatments and outcomes for patients with cardiothoracic disease.
References 1. Ellison RG. Significant events in the history of The Society of Thoracic Surgeons. Ann Thorac Surg 1972;14:577–604. 2. Wood DE. The future of cardiothoracic surgery: a view from North America. Eur J Cardiothorac Surg 2013;43:241–3.
