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August 2001
Volume 65 |
Number 8
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| The Future
of Anesthesiology in Critical Care |
Robert N. Sladen, M.B., Ch.B.,
President
American Society of Critical Care Anesthesiologists
In 2001, the future of anesthesiology in critical care is in
jeopardy. Never before has there been so much interest among anesthesiologists
in joining their parent society — ASA now boasts more than
36,000 members, of whom 24,000 work in the United States. Never
before, however, has there been so little interest among anesthesiologists
in joining the American Society of Critical Care Anesthesiologists
(ASCCA). In the last two years, our active membership has declined
from 650 to 550 members. In part, this reflects the minuscule
involvement of anesthesiologists in critical care in the United
States today. Of 24,000 ASA members, only about 850 are actively
engaged in the practice of critical care — that is, less
than 4 percent of American anesthesiologists. Through continued
dialogues with the leadership of ASA, the American Board of Anesthesiology
(ABA) and the Residency Review Committee (RRC), ASCCA is striving
to enhance the recognition, standing and attractiveness of critical
care as an integral component of anesthesiology practice.
ASCCA is urging ABA and RRC to develop a rational and progressive
program of critical care training within the clinical base year
and through the CA-3 year. ASCCA believes that an increase in
the overall exposure to critical care for graduating residents
from the current two months to perhaps five or six will better
prepare them to work alongside their colleagues in surgery or
pulmonary medicine. By providing increased supervisory responsibility
at a senior level during the CA-3 year, residents may better appreciate
the intellectual satisfaction of intensive care unit medical direction
and more likely consider doing a fellowship in critical care.
ASCCA believes that the best hope for achieving a revitalized
role for anesthesiologists in critical care is to increase recruitment
of excellent residents into anesthesiology critical care fellowships.
In March 2000 and 2001, ASCCA officers presented the above-mentioned
issues to two Leadership Conferences with the ASA President and
officers and the presidents of ASA subspecialty societies. One
outcome of these conferences is a special article on critical
care anesthesiology titled “Critical Care Medicine: Past,
Present and Future,” which will be published in the September
2001 issue of Anesthesiology. The article is authored by C. William
Hanson III, M.D., Philadelphia, Pennsylvania; Charles G. Durbin,
Jr., M.D., Free Union, Virginia; Gerald A. Maccioli, M.D., Raleigh,
North Carolina; Peter J. Pronovost, M.D., Ellicott, Maryland;
Luciano Gattinoni, M.D., Milan, Italy; and Robert N. Sladen, M.B.,
Ch.B., New York, New York.
ASCCA also was well represented on the recent ASA Task Force
on the Future of Anesthesiology, chaired by ASCCA Past President
Philip D. Lumb, M.B., Pasadena, California. The task force will
soon submit a white paper to ASA that will emphasize the importance
of anesthesiology involvement in critical care. Michael J. Murray,
M.D., Jacksonville, Florida, also an ASCCA Past President, is
Chair of the ASA Committee on Critical Care Medicine and Trauma
Medicine. This ASA standing committee provides an ongoing mechanism
to promote critical care medicine among anesthesiologists.
ASCCA’s Delegate to the ASA House of Delegates, Vincent
L. Hoellerich, M.D., Raleigh, North Carolina, and our Alternate
Delegate, Michael W. Russell, M.D., Philadelphia, Pennsylvania,
have been outstanding representatives for ASCCA. They have brought
to the attention of the ASA House of Delegates the impending changes
in market forces that will create an increased demand for intensivists
in the face of a diminishing supply.
ASCCA is continually engaged in liaison with ASA and the Society
of Critical Care Medicine (SCCM) to oppose the Centers for Medicare
& Medicaid Services (CMS) (formerly known as HCFA) in the
progressive erosion of reimbursement levels for the application
of critical care. In this, we are very well represented on the
ASA Committee on Economics by ASCCA President-Elect Neal H. Cohen,
M.D., San Francisco, California. Dr. Cohen is currently working
with ASA President Neil Swissman, M.D., to develop a joint response
to the recommendation of the Relative Value Update Committee of
the American Medical Association that postoperative critical care
services be bundled into the surgeon’s global fee. Todd Dorman,
M.D., Baltimore, Maryland, Chair of the ASCCA Task Force on Billing
and Documentation, has been indefatigable in communicating up-to-the-minute
changes in reimbursement guidelines and in getting the word out
to our colleagues in ASA and SCCM.
ASCCA, which was founded in 1986, provides for the specialized
needs of intensivists as well as the broader needs of practicing
anesthesiologists. All ASA members are encouraged to join ASCCA
and to support its efforts to promote the role of anesthesiologists
in providing critical care services. We ask that you visit our
Society’s Web site at www.ascca.org
to learn of the benefits and services an ASCCA membership has
to offer. You may also e-mail us at ascca@ASAhq.org
for more information.
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Robert N. Sladen,
M.B., Ch.B., is Vice-Chair, Department of Anesthesiology,
Columbia Presbyterian Medical Center, New York, New York. |
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