After World War II, the establishment of the Department of Medicine and Surgery in 1946 created an environment encouraging excellence in patient care in the VA system as well as increasing emphasis on teaching and research. Due to this major change in the system, a large number of highly qualified and dedicated surgeons joined Veteran’s Administration Hospitals’ staffs during the ensuing years. In the mid and late 1950’s under the inspiring leadership of the Director of Surgery, Dr. John A. Kennedy, and the Director of Research in Surgery, Dr. Lyndon E. Lee, a large group of these surgeons became acquainted and close friendships developed. Numerous meetings of various groups involved in highly productive Cooperative Research Studies in Surgery, such as those in Peptic Ulcer Surgery, Urological Research, Coronary Artery Disease Surgery, Esophageal Varices and the Surgical Adjuvant Cancer Chemotherapy Group, fostered these associations and made evident the importance of VA Surgeons in future progress in surgical patient care, education and research in the United States. In addition, a number of regional surgical meetings were held and two outstanding national symposia were organized. Common goals and problems were evident in the many informal discussions at such meetings.

In 1964, Dr. Kennedy, the long-time Director of Surgery, announced his retirement and a testimonial dinner was organized and held at the Annual Clinical Congress of the American College of Surgeons on October 5, 1964. This was attended by a number of his close friends and associates in the VA surgical community. The interest and enthusiasm shown by a large number of VA Surgeons throughout the country to unite and honor Dr. Kennedy strengthened the feeling that the time was ripe for a national organization of VA Surgeons outside the formal administrative structure of the Veterans Administration. Similar dinner meetings were held in Atlantic City in 1965 and San Francisco in 1966 with excellent attendance.

Following many informal discussions, in 1967, the Chiefs of the Surgical Service at all VA Hospitals were polled relative to attending an organizational meeting at the time of the American College of Surgeons Clinical Congress in Chicago, October 2, 1967. The response was very encouraging and hence on that date, the Association of Veterans Administration Surgeons was formally launched with 51 surgeons present as founding members and 17 surgeons who had committed themselves by mail to join the organization as initial active members. The stated purpose of the organization was to “improve patient care, medical education and research in surgery in the Veterans Administration.” The original slate of officers elected was Dr. Lloyd S. Rogers, President, Dr. James Thoroughman, Vice-President, Dr. William G. Mallette, Secretary and Dr. H. Brownwell Wheeler, Treasurer. During the following year a formal constitution was drawn up by the officers and this was adopted at a meeting of the Association in 1968.

At the annual meeting in 1969, the Association’s Distinguished Service Awards were established and the first two were presented to an Honorary Member, Dr. John Paul North, and a Founding Member Dr. Ralph T. Bowers, for their outstanding contributions to Veterans Administration surgery. These awards have been continued. At the annual meeting in 1971, Dr. Lloyd Rogers, the first president and Dr. George A. Higgins, the fourth President, presented the official gavel to the organization. This is made of wood from the White House and is mounted on a base of oak, obtained from an original building at the VA Center, Togus, Maine, which is the oldest Veterans Administration Hospital. It was originally opened as the first National Home in 1866. It has now become traditional for each President to receive a replica of the gavel from the Association in recognition of his or her service. In 1972, an Annual Essay Award was established to recognize the best paper submitted by a surgical resident from one of the Veterans Administration Hospital Surgical Services.

Dr. Paul Jordan, the ninth President, reemphasized the interest of the Association in continuing education and in response to a strong mandate from its members, initiated a major effort to establish an annual scientific meeting of the high quality representative of the professional maturity of the Association. In 1977, with the cooperation of Dr. Carl Hughes, Director of Surgery, the First Annual Symposium occurred in Nashville, Tennessee on May 2-3, 1977 at the Vanderbilt Holiday Inn with Dr. Raymond Read as program chairman. It had both a Continuing Education in Surgery program with a distinguished national recognized faculty as well as scientific papers presented by residents and members. This event was viewed as the first in a series of annual educational meetings of the AVAS as the organization sought to grow to satisfy its purpose. Similar format meetings were next held in venues such as St. Louis, Minneapolis, Atlanta, Virginia, and Los Angeles. By 1982, the more traditional format of the meeting ensued involving mostly papers in the scientific session being presented interspersed with review sessions. The Annual Business Meeting, Council of Chiefs Meeting and the Social Activities were now a regular part of the program. It was a four day meeting at this time with scientific sessions running from Wednesday until Saturday morning. Due to the keen competition for abstracts to be accepted and subsequently presented, a Poster session was instituted in 1984. The Constitution, By-laws and Membership Directory were now a part of the Annual Symposium proceedings. A “Local Program” where the host institution would present its departmental clinical and basic science activities became a popular venue for knowledge.

In the 1980’s there was an explosion of scientific knowledge in medicine and as this scientific discovery became mature it was often presented at national meetings. The AVAS program, which had both clinical and basic science papers presented, saw an explosion of basic science papers presented, often to the disapproval of some AVAS members who were often not familiar with the content and language of the presentations. This was true until the late 1980’s and early 1990’s when an emphasis on clinical outcomes became popular as well as scientifically investigated and thus there became a nice mix of both clinical and scientific presentations. The NSQIP data base championed by the late Dr. Shukri Khuri rapidly became a frequent abstract presented. Liaison Committees in Anesthesia and Orthopedic Surgery developed as well. In addition to the best resident clinical and basic science award being chosen by the awards committee, the Lloyd Rogers Award for the best poster was instituted in 1998, which over time was designated as the best overall paper. Soon an emphasis on health care delivery and quality of care became paramount in the VA hospital setting and these results were subsequently translated into meaningful abstracts and resident/member presentations. It would soon be common for medical students, physician assistants and laboratory scientists to present their paper with sponsorship by an AVAS member.

Over time, the burden of being away from work and families with a four day meeting format soon changed and the meeting would be three days beginning on a Sunday afternoon and conclude on the following Tuesday afternoon at noon. The Executive Committee would often have a dinner the Saturday night before the symposia began the next day and often was at the home of the local arrangements chairman. As hotel accommodations became challenging in some cities, there were instances when a “compressed meeting” from Saturday until Monday occurred. In an effort to keep AVAS members and residents current on topics such as advances in basic science, operative techniques, disease based therapies, grant writing, and career development, a pre-meeting symposium was instituted the morning of the first day of the meeting and became both popular and at times published as part of the papers from the annual symposia.

The social activities during the annual meetings were an important part of the program. This often included an open afternoon when the membership would be transported to a local historical landmark, museum, or even to travel to the ballpark to attend a baseball game. As members and residents would often have family members accompany them to the meeting, a spouses program was developed by wives of local surgeons and often included afternoon fine dining, shopping and tours. The annual banquet, often the highlight of the meeting traditionally would have either a local celebrity or a representative from Central office give a 30-45 minute oration of their choosing. As this was often hit or miss regarding popularity, subsequently the outgoing president would give his Presidential address on a topic of his choosing and often it would be published in meeting symposia. This was often preceded by a good natured “roasting” of the President by the incoming President- Elect.

As the Association moved into the twenty first century there were many new things that happened. The advent of power point technology made the technical quality of the papers presented superb. Minimally invasive surgery was now in full swing and there were many papers on emerging technology that were presented. The financial health of the organization continued to improve and the availability of resources for new initiatives was available. Julie Freischlag, M.D. became the first woman AVAS president in 2000. The AVAS Foundation, initiated in 2003 became a vehicle to fund young investigators at a start-up level. New venues previously unchartered for hosting the national meeting such as Miami, Florida, West Haven, Connecticut and Virginia Beach, Virginia occurred. The vehicle for publishing papers from the meeting evolved from Archives of Surgery in the 1970’s and 1980’s to the Journal of Surgical Research in the 1990’s and currently the JAMA Surgery. Currently the membership of the AVAS plays an active role in the peer review process. With the continued increase in abstracts submitted, and in an effort to allow for more presentations, “Quickshot” three minute oral presentation sessions were incorporated into the scientific program in place of the poster sessions.

There has been continued growth of the Association since its founding. Now in its 48th year, membership has reached approximately 500 members. Recognition of the dedication of the membership to improving all aspects of surgery in the VA has occurred throughout the Veterans Administration. Many members of the AVAS have risen nationally as Chairpersons, Sections Chiefs, Residency Program Directors, VA Chiefs, CEO’s and leaders within their community. Members have actively assisted other members in departmental and national advancement on a regular basis. Lifelong friendships have remained for countless members whose initial meeting was at an AVAS event. The camaraderie among members and that warm feeling and special relationship when one recognizes a current or former AVAS member at a national meeting or social engagement remains priceless. A “coffee table” type book is currently being planned to celebrate the 50th anniversary of the AVAS in 2017.

Walter E. Longo, MD

Archivist

Past President AVAS