The physician, patient, and third party.

ht' Amf'rif'flfi r.oll t:gp of SllrgPOIls \Va.o.; t'slahlished by !,'rankJin II. Martin and his Chicago as,'ioC'iall's ill Hll:3, for llil' lIIu~t I)Cl rl" Lo improve the quality of care of the sUf,:;:ical patient and the quality of the operating room environlllPnl find 1,0 anvann'! rht-' )wi"'rH't' of slIrgt'ly All of these goals were endorsed and su pported by t.he Mayo uruLhefs .md the institution with which [ have been associated durinp; illY surgical career. Its founding, however, was surrounded by controversy within thf' medical proff'ssioll. OUlspokl-'1I critics in the profession said that the College was being urgaui;.:ed .slrieLly for the nl1<lIIdal galll of those who could put "FACS" after the MD following their names. ThiS attitude is well described in the book, Fellow shill (if S/lrg~(}/ts, by Lt,.val Oavis. Today, 75 years later, the eehoes of financial matters have once again ~ornt' the lIIail1 theme heard by the profession. Medicine is bcillA driven by financial concernsmostly caused by external forcesand not so much by Iht" Hf'ad, Iht" Hearl., and Ihf' Hand, as f'xp rf'sst'd by Jim Priestley in 1954 in a Presidential Address. As a surgeon, I had hoped to dwell in this address on a scientific topic 01' a scie ntific advance, but unfortunately, the socioeconomic cl1anges that are occurring loday a rt' Iht' fIlOS!. p rt'ssitlg prolJl~'llls f~l(:i llg physicians and their patients. Yes, these changes may :.lffeet (lie pockelbook , UUl the real l,;Ollcern is that they will havc an adverse effect on the quality of care and the people's access to it. 'I'llIf't.n il.<; purpost', tilt' Coll t'gt~ hlls givell uirth tu activities thut have improved the Quality of patient eart'--lIotably the JOlllt Commission on Accreditation of Hospit.als, now the .Joint Commission on AI'credltation of IIealthcare Organizations. Likewise, the CoI1f'gf' fo r mf'd Ihf' COIlllllissioll 011 C~ulf'er, which has multidisciplinary participation; the Committee 011 Tm ullla, whic h sponsors a Trauma Center Ve rification Pro.l':ram: and thf' Committf'~ on I he Operalmg Room Emironment, it s ponsors the annual Clinit'al CtUlgrt'ss ( 111e largest s llrgkal Illeeting in the world ); and it develope d the Sur,ltical Education and Self-Assessment Program (SESAP), t he Pat ient SqfCI.11 Man ual, and other educational programs and scholarships. An endowment program has just been f'sl.allli ."ht'd 10 Iwlp IIlIderwrite SOll1e of these pro-