For the past few years, i have had the rare honor of serving the surgical profession in 2 important roles: first on a national basis as executive director of the american college of surgeons (acs) for a little more than 3 years and second on a regional basis as the president for 1 year of this fine organization, the pacific coast surgical association (pcsa). in both capacities, i often find myself contemplating the future of the profession and how organizations such as the pcsa and the acs can shape it.