August 2001
Volume 65 |
Number 8
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ADMINISTRATIVE UPDATE
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Who Is Responsible for the Future?
Orin F. Guidry, M.D., Treasurer
ASA President Neil Swissman, M.D., appointed a Task Force on Graduate
Medical Education to study ways that ASA can support academic anesthesiology
in accomplishing its mission of educating the next generation of
anesthesiologists. The creation of the task force was partially
prompted by the publication of the Society of Academic Anesthesiology
Chairs/Association of Anesthesiology Program Directors (SAAC/AAPD)
document “Surviving the Perfect Storm: The Financial Environment
of Academic Anesthesia.”
This document provides insight into the challenges facing academic
anesthesiology and is available on the SAAC/AAPD Web site www.asahq.org/aapd-saac.
Workforce concerns continue to receive attention with the April
2001 ASA NEWSLETTER article “Where Have All the Anesthesiologists
Gone? Analysis of the National Anesthesia Worker Shortage”
by Gifford Eckhout, M.D., and Armin Schubert, M.D., available
on the ASA Web site at www.asahq.org/NEWSLETTERS/2001/4_01/eckhout.htm.
The task force, which includes J. Jeffrey Andrews, M.D., Steven
J. Barker, M.D., Alex S. Evers, M.D., Roberta L. Hines, M.D.,
Joseph G. Reves, M.D., and Kevin K. Tremper, M.D., met and has
begun its work. Among the issues considered are the size of the
anesthesiologist workforce, ways to increase medical student interest
in anesthesiology, factors that determine the number of residency
positions and ways that the specialty can strengthen academic
medicine.
One task force member pointed out that a way anesthesiologists
in general could assist academic anesthesiology would be to voluntarily
teach in local residency programs on a regular basis. This would
have multiple benefits. The academic staff would have additional
nonclinical time; the residents would benefit from a more varied
approach to anesthetic problems, exposure to “real world”
issues and another set of role models; and the visiting anesthesiologist
would have increased contact with an academic environment and
would be able to closely observe potential new hires among the
residents. It is a “win-win-win” situation.
My professional career illustrates all the above points. I practiced
briefly in an academic institution, spent more than 20 years in
a conventional “private practice” and recently moved
to a multispecialty clinic with an anesthesiology residency. I
put “private practice” and “private practitioners”
in quotes because these are hard terms to define, and perhaps
their use further divides us. What unites us is that we all care
for our patients; the business aspects of that relationship are
much less important. This concept of “private practitioners”
being active in resident teaching either could have or did affect
me at each step.
When I was a resident, “private practitioners” from
“town” would spend time with us in the operating rooms
in the afternoon. It was enlightening to see another approach
to problems. The “private practitioners” from “town”
offered me a job when I was ready to leave academic medicine.
They knew me and I knew them. It was an easy decision and a good
match, and I worked in that group from 1977 until 1999.
One of the reasons I decided it was best for me to leave this
thoroughly enjoyable “private practice” was my concern
about professional stagnation. Others may be more motivated than
I am, but it is hard to go home and read after a long day in the
operating room. However, nothing stimulates learning more than
trying to stay ahead of bright young anesthesiology residents.
Perhaps I would have stayed in “private practice” if
I had been regularly exposed to this sort of stimulation.
Now I am responsible for the education of residents. Others from
the outside and I bring a different view than the other teachers
here — not necessarily better or worse, just different. The
residents would be developing natural contacts with potential
future employers and associates. The full-time staff would welcome
having “private practitioners” in the operating rooms
and more nonclinical time for their academic and administrative
duties. Why do I not have “private practitioners” from
New Orleans (my hometown) involved in teaching our residents?
I am embarrassed to say that I just did not think of it. We certainly
have many excellent anesthesiologists in “private practice”
in this area, and I just have not gotten around to asking.
What do the teaching programs need to offer in return to the
“private practitioners?” A sincere invitation to participate,
minimal credentialing and administrative hassles, a good parking
spot, a first-rate didactic program, access to audiovisual services
and the medical library, respect for different ideas and viewpoints,
invitations to Journal Club and, most importantly, the opportunity
to spend time with bright residents.
This concept has great potential. Every training program in the
country should consider how it could be implemented in their respective,
unique environments. Every anesthesiologist should be receptive
to the invitation to teach.
The responsibility for teaching future generations rests with
all of us.
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