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July 1996
Volume 60 |
Number 7
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| Letters to the
Editor |
Anesthesia Externship -- An Alternative to the ASA Preceptorship
The continuing decrease in numbers of medical students selecting
postgraduate training in anesthesiology via the National Resident
Matching Program combined with increasing interest in reinstituting
the ASA Preceptorship Program has prompted us to describe the
Sophomore Medical Student Externship Program recently introduced
by the Indiana University School of Medicine Department of Anesthesia.
Beginning in May 1995, the department offered a four-week externship
to students who were on summer vacation following completion of
their first year of medical school. Announcements were distributed
in February 1995 to 280 first-year medical students describing
the availability of a four-week anesthesia externship in each
of the four teaching hospitals (Indiana University Hospital, Riley
Hospital for Children, Wishard Memorial Hospital and Veterans
Administration Hospital) utilized by the department.
This externship was approved by the Curriculum Committee of the
medical school with the understanding that the four-week externship
would not be credited toward graduation requirements, including
the required two-week rotation in anesthesiology during the final
year of medical school. Applicants were told they would be assigned
to the operating rooms Monday through Friday with an anesthesia
faculty or senior anesthesia resident for the entire four weeks.
Availability of additional experiences in critical care medicine
and pain management were also described. The goals of the externship
were to introduce the students to the specialty of anesthesiology
and also provide them with a patient care experience early in
medical school.
A total of 13 applications were received and 12 students were
selected after a personal interview with two anesthesia faculty.
The department provided these 12 students with an introductory
anesthesia textbook, Basics of Anesthesia, and a stipend
of $1,000. Students were assigned reading in the textbook and
invited to attend departmental teaching conferences. At the completion
of the externship, the students met with the chair of the department
to critique their experiences. Students also completed a detailed
questionnaire and course evaluation form. Every student characterized
the four-week externship as a rewarding educational experience
that broadened their medical horizons and provided them with an
introduction to the specialty of anesthesiology.
The externship is being offered again for 1996, and 22 applications
were received from 280 students. It is anticipated that 12 externship
positions will be provided.
We believe this anesthesia externship as developed, sponsored
and funded by our department represents an exciting opportunity
for students to learn about anesthesiology in the early and formative
years of medical school. This is critically important, as changes
in the medical school curriculum at Indiana University School
of Medicine (and presumably other medical schools) continue to
emphasize "primary care" often at the expense of time
in the curriculum that previously had been available for medical
student rotations in anesthesiology.
It is hoped that this early exposure to anesthesiology will prepare
senior medical students to make informed choices for postgraduate
training.
Jonathan M. Anagnostou, M.D.
Philip S. Biggs, M.D.
Robert K. Stoelting, M.D.
Indianapolis, Indiana
Superspecialists Unwelcome
"As a 13-year member of your Society, I would like to discuss
a very disturbing trend that I think is counter to the public's
well-being and to our profession," stated pain specialist
Dennis E. Karasek, M.D. [April 1996 NEWSLETTER, page 34].
Here are some thoughts from a 23-year member of "our Society"
on the exclusive contract.
In most medical specialties, there is a requirement to provide
services 24 hours per day, 365 days per year. Anesthesia is certainly
no exception. A problem we all face is how to appropriately provide
these services while dealing with the decrease in efficiency and
reimbursement for night and weekend work. Group practice is almost
universally the format used to make this care available.
Now come the "superspecialists." They have grown weary
of 2 a.m. telephone calls, so they become fellowship-trained.
Suddenly they become expert at putting needles in the epidural
space for handsome fees Monday-Friday, 9 a.m. to 4 p.m., but unable
to do a labor epidural after the sun sets. The superspecialists
wail that they do not wish to practice "surgical anesthesia"
anymore. Caring for a patient with a ruptured AAA at 3 a.m. reminds
us how smart this decision could be.
Finally, the superspecialists pretend not to understand why I
would not welcome them with open arms to my hospital staff so
they can skim the little cream that is left in my practice. Today,
perhaps more than ever before, we need superspecialists who will
come home from fellowships and join the patient care team rather
than become arrogant and aloof while attempting to take financial
advantage of former partners, friends and colleagues. Exclusive
contracts prevent the chaos the superspecialists of this world
can create.
Stephen B. Campbell, M.D.
Tulsa, Oklahoma
A Rose by Any Other Name...
In the May 1996 ASA NEWSLETTER, Norig Ellison, M.D., wrote
"What's in a Name?" In other articles, anesthesiologists
wrote that up until this point anesthesiologists have been confined
to the operating room. It still surprises me that our medical
colleagues and even the surgeons that we work with do not know
and understand what we do. It should come as no surprise that
our patients haven't a clue as to what we do for them either.
After reading the NEWSLETTER, it seems more important for
anesthesiologists to educate those we work with and take care
of than to worry about what we call ourselves.
A rose by any other name is still a rose.
Shari M. Yudenfreund-Sujka, M.D.
Winter Park, Florida
Nurse Anesthetists' Testimony to Judiciary Committee 'Untrue'
Minnesota Association of Nurse Anesthetists President Gayle McKay
alleges that it was reported recently in Great Falls, Montana,
that there are "Hospital- and/or anesthesiologist-inspired
boycotts against nurse anesthetists." This is untrue. No
boycott exists. Certified registered nurse anesthetists (CRNAs)
are free to compete as independent practitioners in Montana and
do so in Great Falls today.
The untrue allegation continues that the anesthesiologists "didn't
want to administer epidural blocks because they would be required
to remain with the mother for several hours until she gives birth,
which would cut down on the number of patients for which they
are paid." For the past four years, a board-eligible or board-certified
anesthesiologist has been exclusively assigned to providing the
obstetrical service 24 hours a day, 365 days a year. Many days
per month, no anesthesia is required; consequently, the assigned
obstetrical anesthesiologist receives no reimbursement. Nevertheless,
he or she continues to provide this obstetrical anesthesia service
as a community service. This "lack of coverage" was
untrue and subsequently retracted by the newspaper last summer.
Montana has all combinations of anesthesia services in the state.
There are approximately 150 anesthesia providers in Montana. About
70 are anesthesiologists, and the remainder are nurse anesthetists.
We have some communities where surgeons request only M.D. anesthesia,
while others have M.D./CRNA anesthesia care teams. In some small
rural communities, solo independent CRNAs provide a valuable service
as the only available anesthesia providers.
Antitrust laws, with or without the "per se" rule, allow
CRNAs to compete in the larger communities. Much has been said
about the potential oversupply of anesthesiologists in large metropolitan
areas in the United States. I am not a lawyer, but I would suggest
that these same laws permit anesthesiologists to compete in America's
rural communities that currently have only CRNAs.
Mike P. Schweitzer, M.D., President
Montana Society of Anesthesiologists
Billings, Montana
Another of the Few, the Proud
In light of the recent "My Dad is bigger than your Dad"
chest-pounding among third-generation anesthesiologists responding
in the ASA NEWSLETTER, I feel obligated to join the foray
with an update. I believe caution should be exercised whenever
claiming to be the best, smartest, fastest or most of anything
in life as invariably there will exist someone else who is not
only more qualified but also less inclined to announce it. Accordingly,
I am hesitant to take the "three-generation dynasties"
theory to the next level.
Not only are both my father and grandfather anesthesiologists
(with all three of us training at Los Angeles County Hospital),
my great-grandmother Dr. Maude Callison (incidentally trained
at the California College of Medicine located across the street
from what was to become Los Angeles County Hospital), practiced
as an internist/ophthalmologist performing surgical anesthesia
(ether mostly) for her patients as well as for other physicians
in the outlying area. I realize that "fourth-generation"
may be rather loosely defined because my great-grandmother did
not exclusively devote her career to the practice of anesthesiology
and because every scrub tech and his cousin may have been "qualified"
to administer ether at the turn of the century; however, familial
ties to the field beyond that time appear tenuous at best (without
choosing to argue the analgesic properties of a stiff belt of
whiskey during the 1800s -- can this be considered a valid interpretation
of the practice of anesthesia?).
Gregory S. Kearl, M.D.
Los Angeles, California
Many Faces, Many Perceptions
Although I have been retired from anesthesiology for some time,
I still enjoy receiving the ASA NEWSLETTER. I was particularly
impressed by the cover of the May 1996 issue, depicting some of
the many faces of the anesthesiologist as the "perioperative
physician."
However, I was disappointed to note that the individuals "in
control" in each situation were men. This seems to ignore
the contributions, over the years, of women in the specialty and
to perpetuate the outmoded perception of medicine as a "male
only" profession.
Gwendolyn C. Trudeau, M.D.
Columbus, Ohio
Editor's Note: The writer's concerns are noted; however,
all materials used in the NEWSLETTERs are chosen with a
conscious effort to avoid stereotypes. Several years ago, ASA
undertook the momentous task of reviewing and correcting all official
documents in order to ensure "bias-free" content. As
an official publication of ASA, we also adhere to this philosophy.
--E.L.
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