How do we preserve the future of anesthesia?

[TeslaCoil]

In light of all of the apocalyptic threads regarding the future of anesthesia practice, I thought it would be nice to start one where people might suggest how we can prevent the supposed impending doom, whether it be through political action such as lobbying, or otherwise. Please folks, can we not let this one deteriorate into a "medicine sucks and anesthesia is no different, we're all gonna be screwed in X years" type of thread?

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[bashwell]

In light of all of the apocalyptic threads regarding the future of anesthesia practice, I thought it would be nice to start one where people might suggest how we can prevent the supposed impending doom, whether it be through political action such as lobbying, or otherwise. Please folks, can we not let this one deteriorate into a "medicine sucks and anesthesia is no different, we're all gonna be screwed in X years" type of thread?

It seems to me a lot of what's relevant to anesthesia is relevant to all of medicine. In that respect, we'd have to change healthcare overall (whether someone is for/against Obamacare). Although this is very vague, I personally think we should somehow maximize the physician patient relationship and minimize the intrusion of middlemen like the government and insurance companies coming in between physicians and patients. Some regulation and the like is unavoidable, of course.

As much as possible, hire more AAs over CRNAs. Although I realize this isn't possible in every state, and (ironically) the AANA fights very hard against expanding AAs.

 

[TeslaCoil]

But as physicians, what do we actually do... do we go out and actively solicit representation of some sort? do we avoid employment under certain practice models? how do we go about getting it all done? is there something similar to a union we could form?

Seems kind of hard to remove middlemen, especially in anesthesia, considering we technically depend on other physicians and/or organizations to come up with patients...

 

[bashwell]

But as physicians, what do we actually do... do we go out and actively solicit representation of some sort? do we avoid employment under certain practice models? how do we go about getting it all done? is there something similar to a union we could form?

Seems kind of hard to remove middlemen, especially in anesthesia, considering we technically depend on other physicians and/or organizations to come up with patients...

Lots to say but just a quick correction as I'm about to rush off but I didn't say "remove" but instead "minimize".

 

[deleted171991]

It's very hard to change a healthcare system, so you'd better just avoid anesthesia altogether. Even an MBA is a better "residency" and investment.

Find yourself a better specialty, preferably a procedural one, while you're still a medical student. Be one of the rainmakers, not one of their minions.

 

[GA8314]

Your question presumes that the issues we face are unique to anesthesia. They are not. Some may suggest they are, however.

Stay engaged in the political/PAC process. Stay close to your state SA. Work hard. Be proactive in your group. Volunteer/run for important committees in the hospital. Know your craft. Constantly attempt to improve. Show up to work ready to work hard. Take pride in what you do. Never let your hands on skills waiver if supervising. Look for ways you can expand your influence in the hospital system. You can indeed be looked upon as an asset by administration if your group (and you) do certain things right (such as suggested above).

Otherwise, nobody has any holy grail answers. Control what you can, and enjoy life. Don't be a martyr for sh.t you can't control. Make attempts to influence what you CAN control. Live within your means. Save and invest early.

That's all I got...

 

[Man o War]

My suggestions are 1) don't be lazy. Surgeons, administration, nurses, etc see it and it will bite you. Manage perceptions 2) Subspecialize. My job search as a generalist was far different than my job search after fellowship 3) On a personal level, do not be married to a certain city/region. That's how you get screwed. There are good jobs out there to be had, but you have to be flexible on your location. 4) Keep your skills up and stay relevant. See #1 5) Go to meetings at the hospital, make your presence known, get to know your administrators, get a seat at the table with your surgical counterparts. Again, see #1.

 

[Stank811]

1) AMC growth will slow down so be patient and ride them out unless you are 5 yrs away from retirement and want to sell out or your plan is to destroy your current group and move in 5 yrs. Or maybe your group is already horrible and you want to join an AMC...who knows

2) A lot of the prediction of our speciality getting worse is based on the concept of bundle payments. How do you make your group obtain a larger chunk of he pie...increase your groups footprint (surgical home).

3). If you belong to a group that uses mid levels employ AAs and CRNAs

4) Support the ASA and give to the PAC

 

[GA8314]

My suggestions are 1) don't be lazy. Surgeons, administration, nurses, etc see it and it will bite you. Manage perceptions 2) Subspecialize. My job search as a generalist was far different than my job search after fellowship 3) On a personal level, do not be married to a certain city/region. That's how you get screwed. There are good jobs out there to be had, but you have to be flexible on your location. 4) Keep your skills up and stay relevant. See #1 5) Go to meetings at the hospital, make your presence known, get to know your administrators, get a seat at the table with your surgical counterparts. Again, see #1.

Good post. I agree with most but not necessarily point 2, although I'm not disputing your experience at all.

Remember that a lot of the issues with anesthesia are OUR doing. Especially in SOME ACT models where docs have become very lazy. It doesn't have to be that way, however. There are lots of opportunities for improvement.

Enjoy the profession you have chosen. Be a leader in your profession. That does NOT necessarily mean taking on a major traditional "leadership" position. You can have a BIG impact right where you are at work. Just lead, daily, by good example. Be the type of anesthesiologist that people value and respect. This is 100% within your control.

 

[criticalelement]

There are good jobs out there to be had, but you have to be flexible on your location.

The above statement will always be correct. The problem is one cannot always be flexible. Once you have children and a wife with a job and a house and your whole life vested in an area and a job... well.. its not easy (and never will be) to pick up and move. that is recipe for divorce, losing everything you have etc etc etc.. Dramatic right? ive seen it happen.. A few times in my career. Would i want to live like that? Absolutely not. Truly nerve-racking. Everyday worrying about whether today is the day where you will be fired or cancelled in 90 days. No wonder anesthesia chiefs are invertebrates.

the problem with anesthesia is that it is a service profession. They can and will widgetize you. (anesthesia on, anesthesia off.). What is so fu ckin hard? Ask Joan Rivers. Once you are widgetized, your unique skills are no longer valuable. Any old doc or crna for that matter can do what you do.

Ultimately, the problem is lack of leadership in our specialty.

 

[IlDestriero]

We don't have lack of leadership, just look at the surgical home. <sarcasm detector should be pinging here>

 

[criticalelement]

We don't have lack of leadership, just look at the surgical home.

I am against the surgical home.

Why?

Not because I dont wanna do the work, which I don't, but I don't want to take the thinking away from the surgeons. I want the surgeons to know about their patients. I love asking the orthopedica surgeons, How is Ms. jones asthma doing? Did you give her preop albuterol? Is she wheezing? Do you think i should give her steroids in the OR? How is Mr. Smith's Afib doing? Did you stop the coumadin? etc etc.. That is their job, and if they cannot do it, they should enlist some folks to help them in the form of INTERNISTS.

 

[ERRES2288]

How are MD only groups seen by others in the hospital in terms of respect and value? Certainly it must be better than ACT models or am I wrong in that thinking?

 

[IlDestriero]

If the cases get done and start on time and the leadership steps up and provides all the services needed without a lot of headaches and hands out, nobody cares much about anesthesia, until they call a code on a difficult airway patient. Then all of a sudden we are superstars.

 

[TeslaCoil]

The above statement will always be correct. The problem is one cannot always be flexible. Once you have children and a wife with a job and a house and your whole life vested in an area and a job... well.. its not easy (and never will be) to pick up and move. that is recipe for divorce, losing everything you have etc etc etc.. Dramatic right? ive seen it happen.. A few times in my career. Would i want to live like that? Absolutely not. Truly nerve-racking. Everyday worrying about whether today is the day where you will be fired or cancelled in 90 days. No wonder anesthesia chiefs are invertebrates.

the problem with anesthesia is that it is a service profession. They can and will widgetize you. (anesthesia on, anesthesia off.). What is so fu ckin hard? Ask Joan Rivers. Once you are widgetized, your unique skills are no longer valuable. Any old doc or crna for that matter can do what you do.

Ultimately, the problem is lack of leadership in our specialty.

Any suggestions for bettering formal leadership would be awesome.

 

[TeslaCoil]

I am against the surgical home.

Why?

Not because I dont wanna do the work, which I don't, but I don't want to take the thinking away from the surgeons. I want the surgeons to know about their patients. I love asking the orthopedica surgeons, How is Ms. jones asthma doing? Did you give her preop albuterol? Is she wheezing? Do you think i should give her steroids in the OR? How is Mr. Smith's Afib doing? Did you stop the coumadin? etc etc.. That is their job, and if they cannot do it, they should enlist some folks to help them in the form of INTERNISTS.

I feel like this sort of attitude may just be contributing to the problem... No offense...

 

[TeslaCoil]

It's very hard to change a healthcare system, so you'd better just avoid anesthesia altogether. Even an MBA is a better "residency" and investment.

Find yourself a better specialty, preferably a procedural one, while you're still a medical student. Be one of the rainmakers, not one of their minions.

Nah. I'm good. Something tells me you're mostly catastrophizing.

 

[criticalelement]

I feel like this sort of attitude may just be contributing to the problem... No offense...

In what way is it contributing to the problem?

No offense taken at all.

 

[Planktonmd]

We don't have lack of leadership, just look at the surgical home. <sarcasm detector should be pinging here>

 

[Planktonmd]

The only viable solution: Roll with the punches and be happy you are still getting a paycheck!

 

[pgg]

The above statement will always be correct. The problem is one cannot always be flexible. Once you have children and a wife with a job and a house and your whole life vested in an area and a job... well.. its not easy (and never will be) to pick up and move. that is recipe for divorce, losing everything you have etc etc etc.. Dramatic right? ive seen it happen.. A few times in my career.

I've seen it too. But I always figured that a marriage that can't survive occasional relocation was doomed from the start. Something like 1/2 of all marriages end in divorce ... there's a good chance that any divorce "caused by" a job change and move was brewing for other reasons anyway.

Maybe I'm just an insensitive clod. I've moved 5 times, bought 4 houses, sold 2, in the 18 years I've been married. 3 kids, aged 14-17, oldest in college.

Moving isn't easy, but it's not so bad. I suppose the exception would be having a professional spouse with a practice and client base in a given area.

Would i want to live like that? Absolutely not. Truly nerve-racking. Everyday worrying about whether today is the day where you will be fired or cancelled in 90 days. No wonder anesthesia chiefs are invertebrates.

the problem with anesthesia is that it is a service profession. They can and will widgetize you. (anesthesia on, anesthesia off.). What is so fu ckin hard? Ask Joan Rivers. Once you are widgetized, your unique skills are no longer valuable. Any old doc or crna for that matter can do what you do.

Ultimately, the problem is lack of leadership in our specialty.

No, the problem is our leadership gives us the perioperative surgical home.

Meanwhile, the radiologists are putting up signs in the hospital that read

"IS THE PERSON READING YOUR X-RAYS A RADIOLOGIST? ASK."

and stapling posters like this to the wall in the waiting room

 

[Man o War]

The above statement will always be correct. The problem is one cannot always be flexible. Once you have children and a wife with a job and a house and your whole life vested in an area and a job... well.. its not easy (and never will be) to pick up and move. that is recipe for divorce, losing everything you have etc etc etc.. Dramatic right? ive seen it happen.. A few times in my career. Would i want to live like that? Absolutely not. Truly nerve-racking. Everyday worrying about whether today is the day where you will be fired or cancelled in 90 days. No wonder anesthesia chiefs are invertebrates.

the problem with anesthesia is that it is a service profession. They can and will widgetize you. (anesthesia on, anesthesia off.). What is so fu ckin hard? Ask Joan Rivers. Once you are widgetized, your unique skills are no longer valuable. Any old doc or crna for that matter can do what you do.

Ultimately, the problem is lack of leadership in our specialty.

I agree it's totally situational. My wife is totally roll with the punches, and looks at relocating as more of an adventure as opposed to a terrible nuisance. We both moved around a lot as kids and adults, so it just doesn't throw us for a loop. I realize not everyone is in that boat though. Location flexibility is becoming more important than ever though I think with market forces being what they are. There are some nice jobs out there if you can move.

 

[Random Anesthesiologist]

I am against the surgical home.

Why?

Not because I dont wanna do the work, which I don't, but I don't want to take the thinking away from the surgeons. I want the surgeons to know about their patients. I love asking the orthopedica surgeons, How is Ms. jones asthma doing? Did you give her preop albuterol? Is she wheezing? Do you think i should give her steroids in the OR? How is Mr. Smith's Afib doing? Did you stop the coumadin? etc etc.. That is their job, and if they cannot do it, they should enlist some folks to help them in the form of INTERNISTS.

I don't disagree with you, but the quality of optimization by internists and FPs, even cards at times is suboptimal. I get tired of seeing the mod-severe aortic stenosis pt with copd being "cleared" for a hernia surgery and the PCP telling me a spinal is what they recommend and to keep BP.

Yes, this type of stuff happens. Yes, this happens a lot. Then it comes to a point where you say f it, if anyone is going to to "clear" a pt it's going to be anesthesia or surgery.

 

[Random Anesthesiologist]

@pgg agree we need much better PR.

 

[criticalelement]

@pgg agree we need much better PR.

I dont need the internist to give me recommendations as to the type of anesthesia. I need him/her to comment on patients medical ailments and comment on their severity and to comment on whether medical ailments are medically optimized... This is not hard for an internist who knows patient, but a little harder for an anesthesiologist who is seeing patient for the first time. This is not what we do. Moreover, surgeons need to take active part in this process as well rather than write under pmhx ( see anesthesia note).

 

[GravelRider]

@pgg agree we need much better PR.

I think the surgical home can act as PR. Most of us think of the surgical home as scut work managing a diabetic's sugars post-op or rubber stamping a patients as "ok for surgery" pre-op. It certainly can devolve into that. However, the surgical home can act as a PR for an anesthesiology group.

Example:

Patient #1: I went to hospital A and had a knee replacement. I met my anesthesiologist a couple days before the surgery. He went through my medical problems and made sure my heart disease and asthma were well-controlled before we went through with the surgery. He spoke with my internist and we were all in agreement that I was in the best shape possible before the surgery. Boy oh boy was I nervous before the surgery, but knowing that my anesthesiologist knew me well really help put my mind at ease. After the surgery, my anesthesiologist continued to see me and make sure that the anesthetic medications didn't interfere with my medical issues after the surgery. He also made sure that my pain was well controlled afterwards and even sent a letter to my internist suggesting a change in my blood pressure medications. What a great experience. My friend is getting his knee replaced and I will highly recommend going to hospital A because I felt like I was really cared for there.

Patient #2: I went to hospital B and had a knee replacement. I met my anesthesiologist 10 minutes before the surgery, but then never saw him again. I had my surgery and my knee feels great, but I don't even know who my anesthesiologist was.

If we want political clout whether it is in Washington or in our hospitals then we will need the support of the general public...our patients. The days of hammering out cases in the operating room and maximizing our profitability that way are disappearing. We had better start acting like perioperative physicians and not just chart signers.

 

[partydoc]

the problem with that is its almost impossible to get the schedule to line up so you're the one that sees the patient in the pre op clinic, and then do their anes as well. Otherwise that would be great

 

[GravelRider]

Oh I completely understand the logistic problems of it, but I think something along those lines would go a long way in maintaining an anesthesiologist's exposure to patients. It is all about increasing face time with patients...while they are awake.

 

[GA8314]

I think a PSH is a good idea as an adjunct for an anesthesia practice. Just like some groups venture into pain and ICU in order to further penetrate a hospital system and become harder to replace, or simply to add value in as many areas as possible. I don't think it should (nor is anyone suggesting this as far as I know) replace OR anesthesia....

I think we should embrace our MEDICAL training as this, amongst everything else, is a big differentiator from mid-levels.

 

[nimbus]

Oh I completely understand the logistic problems of it, but I think something along those lines would go a long way in maintaining an anesthesiologist's exposure to patients. It is all about increasing face time with patients...while they are awake.

I went into anesthesia to minimize facetime.

 

[GravelRider]

I went into anesthesia to minimize facetime.

Me too. I was an internist before, so I know the pain all too well. However, the realities of the current climate in healthcare is going to dictate what we need to do vs. what we want to do. It's like Darwinism...those who are able to adapt to the changes will survive, those who do not will become extinct.

 

[Spinach Dip]

Oh I completely understand the logistic problems of it, but I think something along those lines would go a long way in maintaining an anesthesiologist's exposure to patients. It is all about increasing face time with patients...while they are awake.

What is this "public relations" of which you speak?

 

[Ezekiel2517]

How do we preserve the future? By preserving what you built. But this isn't being done, people would rather sell what they built to make a quick buck.

 

[GravelRider]

What is this "public relations" of which you speak?

Medicine is increasingly becoming driven by business and politics. As sweet as your smooth wake-up was in the OR, no one cares. No one notices or cares about the near miss you prevented the CRNA from making either. Anesthesiologists need political clout and the best way for that to happen is for patients to demand the best anesthesia care. Anesthesiologists have an opportunity here to make themselves sought after...a marketable commodity that patients seek out. Often times patients are more anxious about the anesthesia rather than the actual surgery. If patients have the opportunity to choose Hospital A vs Hospital B (see my post above) they will be more likely to choose Hospital A and then spread the word about it. This is public relations.

This perioperative home thing is promoted incorrectly by the ASA. For them it is a way to try and dig themselves out of the hole they dug with CRNAs. However, I do think it is a huge opportunity. If anesthesiologists don't capitalize on it then the hospitalists will. I already know of a few hospitals that have a hospitalist driven service that provide perioperative care for orthopedic patients. To me, this is a hospital where the anesthesiology department dropped the ball and missed out on an opportunity.

 

[criticalelement]

. I already know of a few hospitals that have a hospitalist driven service that provide perioperative care for orthopedic patients. To me, this is a hospital where the anesthesiology department dropped the ball and missed out on an opportunity.

That is NOT what we do though!!! That is like asking a marathon runner to run a sprint.

 

[GravelRider]

That is NOT what we do though!!! That is like asking a marathon runner to run a sprint.

We don't medically manage patients undergoing surgery? We don't assess a patient's comorbidities prior to surgery and determine whether or not the risk is acceptable based on the urgency of the surgery? We don't control pain? I could go on and on here...

I am not saying that we need to manage the chronic medications for rheumatoid arthritis or counsel patients on proper diet and exercise like a primary care physician. But to say that we do not medically manage patients in the perioperative period truly reduces an anesthesiologist to a technician. If anesthesiologists are more comfortable sitting in the lounge and signing charts then the field is already dead.

 

[Random Anesthesiologist]

I dont need the internist to give me recommendations as to the type of anesthesia. I need him/her to comment on patients medical ailments and comment on their severity and to comment on whether medical ailments are medically optimized... This is not hard for an internist who knows patient, but a little harder for an anesthesiologist who is seeing patient for the first time. This is not what we do. Moreover, surgeons need to take active part in this process as well rather than write under pmhx ( see anesthesia note).

Of course not. It's not their job. But some have a point that we are medical doctors practicing in the OR. If anyone knows what's best in that environment, it's the consultant anesthesiologist.

I'm kind of back and forth on the idea. Some days I hate it for the extra work, some days I'm open to it for the preservation of the specialty.

 

[Planktonmd]

That stuff they want you to do in the surgical home is already being done by other physicians and they get paid for it! So how do you think they will react to you when you volunteer to do their job for free???
The amount of money insurance is willing to pay for a surgical encounter is going to be constant no matter how many services you add to it, which means if I bill for pre-op visit, in hospital management, and post-op follow up the internist and the hospitalist can't do the same.
This is why this whole idea of the "surgical home" is very stupid!

 

[repititionition]

That stuff they want you to do in the surgical home is already being done by other physicians and they get paid for it! So how do you think they will react to you when you volunteer to do their job for free???
The amount of money insurance is willing to pay for a surgical encounter is going to be constant no matter how many services you add to it, which means if I bill for pre-op visit, in hospital management, and post-op follow up the internist and the hospitalist can't do the same.
This is why this whole idea of the "surgical home" is very stupid!

Said it before and I'll say it again: the way to protect the speciality was/is to play up, not across.

We should be moving far more into the ICU than PSH. Anesthesiology owns acute care across the hospital in other developed nations. Long-term, it's much harder to displace the guy providing critical care than it is pre and post-op medical management.

 

[criticalelement]

Again

Said it before and I'll say it again: the way to protect the speciality was/is to play up, not across.

We should be moving far more into the ICU than PSH. Anesthesiology owns acute care across the hospital in other developed nations. Long-term, it's much harder to displace the guy providing critical care than it is pre and post-op medical management.

Again,there are icu doctors already. Pulmonary docs, critical care medical docs, er icu docs and surg critical care docs. The field is crowded. Why not reclaim our value in the o.r. The leadership in the Asa are a bunch of dummies. That's because they never go into the o.r.

 

[Carbocation1]

The future of both medicine and anesthesia:

 

[Stank811]

Critical element but the profession is evolving and it is much easier for us to show value when we control the whole peri operative environment as opposed to intra-op only.

 

[Planktonmd]

Said it before and I'll say it again: the way to protect the speciality was/is to play up, not across.

We should be moving far more into the ICU than PSH. Anesthesiology owns acute care across the hospital in other developed nations. Long-term, it's much harder to displace the guy providing critical care than it is pre and post-op medical management.

So you are saying it's better to fight other physicians for turf than to reclaim our control over intra-operative management?
Instead of fighting the nurses who are presenting themselves as the anesthesia providers of the future, and instead of affirming that no nurse should administer anesthesia without the supervision of an anesthesiologist, we should find new areas where we can practice some new form of anesthesiology peacefully?
That's exactly what the ASA wanted when they agreed that a CRNA can be supervised by a "physician" not necessarily an anesthesiologist.

 

[criticalelement]

So you are saying it's better to fight other physicians for turf than to reclaim our control over intra-operative management?
Instead of fighting the nurses who are presenting themselves as the anesthesia providers of the future, and instead of affirming that no nurse should administer anesthesia without the supervision of an anesthesiologist, we should find new areas where we can practice some new form of anesthesiology peacefully?
That's exactly what the ASA wanted when they agreed that a CRNA can be supervised by a "physician" not necessarily an anesthesiologist.

ASA a bunch of out of touch dum dums. I would advise you steer clear of anesthesia residency until the smoke clears and you know what you are getting yourself into.

 

[deleted126335]

So you are saying it's better to fight other physicians for turf than to reclaim our control over intra-operative management?
Instead of fighting the nurses who are presenting themselves as the anesthesia providers of the future, and instead of affirming that no nurse should administer anesthesia without the supervision of an anesthesiologist, we should find new areas where we can practice some new form of anesthesiology peacefully?
That's exactly what the ASA wanted when they agreed that a CRNA can be supervised by a "physician" not necessarily an anesthesiologist.

It meant getting something as opposed to losing the battle entirely.

 

[Planktonmd]

It meant getting something as opposed to losing the battle entirely.

We didn't lose the battle, we simply never fought!

 

[Urzuz]

We didn't lose the battle, we simply never fought!

I'm still waiting for the SIMPLEST publicity campaign in the world: "Who would you rather have taking care of you when you go under, a physician or a nurse?" Are they scared to get their hands dirty? Scared they will offend someone on the other side? Taking the higher road is what has led this specialty into the state that it is in today, and the fact that none of them have learned from the past (and present) is pathetic.

The ASA is getting crushed both publicly and politically by the nurses, and it truly speaks to the cowardice and idiocy of our so-called "leaders."

 

[GravelRider]

I'm still waiting for the SIMPLEST publicity campaign in the world: "Who would you rather have taking care of you when you go under, a physician or a nurse?" Are they scared to get their hands dirty? Scared they will offend someone on the other side? Taking the higher road is what has led this specialty into the state that it is in today, and the fact that none of them have learned from the past (and present) is pathetic.

The ASA is getting crushed both publicly and politically by the nurses, and it truly speaks to the cowardice and idiocy of our so-called "leaders."

Because you don't want to bite the hand that feeds you. Supervising 4 rooms make a lot of anesthesiologists rich. If physicians are that much better then why are you splitting your attention between 4 patients at a time? Do the patients even know that you are supervising 3 other cases in addition to theirs? Put your money where your mouth is and go back to physician-only anesthesia. The problem is that there are a lot of old-timers out there that couldn't do a simple case by themselves if their life depended on it.

The bad PR that the ASA is getting crushed on was brought upon by themselves. There are ways to improve the image of the specialty, but that would mean presenting ourselves as physicians to the patients and rest of the staff and not just chart-signers.

 

[repititionition]

So you are saying it's better to fight other physicians for turf than to reclaim our control over intra-operative management?
Instead of fighting the nurses who are presenting themselves as the anesthesia providers of the future, and instead of affirming that no nurse should administer anesthesia without the supervision of an anesthesiologist, we should find new areas where we can practice some new form of anesthesiology peacefully?
That's exactly what the ASA wanted when they agreed that a CRNA can be supervised by a "physician" not necessarily an anesthesiologist.

No, of course not. Then again, there aren't other physicians fighting to deliver anesthesia in the OR, either, so this is a bit of a false dichotomy.

What I think is not in dispute:

1) ASA 1-2 can probably be safely staffed by CRNAs with appropriate-ratio anesthesiologist oversight. Higher acuity cases merit an anesthesiologist providing care directly. THIS IS AN ISSUE WE SHOULD BE FIGHTING TOOTH AND NAIL.

2) The specialty has been substantially diluted by the ASAs lack of effort, and, as others have pointed out, muddy motives on the part of the society's leadership and many in PP who have gotten rich along the way.

3) We keep turning out more and more anesthesiologists.

4) There is an intensivist shortage.

When I add up 1-4 I don't see a strong case for PSH and trying to steal food out of the mouth of the hospitalists (unless you really believe that it will somehow protect us when bundled payments come... And I don't. Anesthesiologists will just have ended up doing more work for the same/less money). I do, however, see a compelling case to encourage push the future of the specialty towards training intensivists.

Half tongue-in-cheek, but nobody calls an intensivist doc "hey ICU". I think this says a lot.

PS - the ultimate ad campaign would be to have a picture of Bill Clinton with a caption like "Even though Bill Clinton's mom was a nurse anesthetist, when the president had surgery, he chose a physician anesthesiologist." Make the point unequivocally -- when you want the highest possible odds of a good outcome (and everyone going in to the OR does), there's one "right choice".

 

[criticalelement]

Because you don't want to bite the hand that feeds you. Supervising 4 rooms make a lot of anesthesiologists rich. If physicians are that much better then why are you splitting your attention between 4 patients at a time? Do the patients even know that you are supervising 3 other cases in addition to theirs? Put your money where your mouth is and go back to physician-only anesthesia. The problem is that there are a lot of old-timers out there that couldn't do a simple case by themselves if their life depended on it.

The bad PR that the ASA is getting crushed on was brought upon by themselves. There are ways to improve the image of the specialty, but that would mean presenting ourselves as physicians to the patients and rest of the staff and not just chart-signers.

Its a matter of access to anesthesia. If we went phyician only everywhere, we would have to train 5-7 thousand anesthesiologists every year. Think about that number. Do you think CMS can stomach footing that bill. the next best thing is the care team as we know it. That is being threatened too now.