August 2002
Volume 66 |
Number 8
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ADMINISTRATIVE UPDATE
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| Taking a Microcosmic
View to Improve Patient Care |
Orin F. Guidry, M.D., Treasurer
I have used my previous opportunities writing these columns to
discuss how the Society manages its finances and how important
it is that the budget accurately reflect the Society's priorities.
This year, with your indulgence, I will again discuss priorities
but from a more philosophical perspective.
In simple terms, the mission of ASA, or for that matter the mission
of all of organized anesthesiology, is to better care for its
patients who are really our family, friends and neighbors.
Quality of care exists at two levels. The first level is the
service that anesthesiology provides the public. There are many
issues that ASA must deal with at this "macro" level.
ASA spends a great deal of time and money dealing with scope-of-practice
issues at the state and federal levels. It is a less visible effort,
but the Committee on Economics and the Washington Office continue
to work vigorously for improvement in reimbursement levels at
the American Medical Association/Speciality Society Relative Value
Update Committee and the Centers for Medicare & Medicaid Services.
The next big issue hitting medicine is malpractice insurance availability
and tort reform.
Another global question concerns the "right" number
of anesthesiologists, and over the years, we probably have done
ourselves more harm than good with our studies in this area. There
is no appropriate and legal way for organized anesthesiology to
influence the production of a certain number of us even if we
could agree on what that number ought to be. These types of issues
determine the availability of anesthesiologists and the overall
environment in which we practice and have been very prominent
"blips on ASA's radar screen."
The second and perhaps more important level of quality of care
is each anesthesiologist's care of an individual patient. I would
like to spend some time talking about some of these "micro"
issues because I think that they get pushed off the front page
by the "macro" issues.
There are three determinants of the care that we delivers to
our patients. The first is that unique body of physiological and
pharmacological knowledge that is anesthesiology. The second is
the quality of the physicians that enter anesthesiology residencies
and how well our residencies train them. The third is how well
those of us far distant from our residency stay current with our
continuously changing body of knowledge.
On a day-to-day basis, we tend to forget how far and how fast
we have come from open-drop ether and a finger on the pulse. I
once traveled a long distance for a final visit with a friend
who was dying of cancer at a fairly young age. He was a bright
and thoughtful person and had a great influence on my education.
During our visit, he voiced no self-pity or regrets about his
life. The only subject he wanted to discuss was the paucity of
fundamental research in anesthesiology. He wondered how we could
be taken seriously as a specialty if we really did not understand
how drugs act to produce anesthesia! Unfortunately, the state
of anesthesiology research is no better now than it was then.
A specialty grows only as its scientific basis grows.
Anesthesiology depends on our academic departments to both nurture
our young researchers and train future anesthesiologists. For
a variety of reasons, academic departments are stressed earlier
and to a greater degree by the many forces that buffet medicine.
Protecting and strengthening academic departments must become
a priority for the specialty.
Discussions are beginning about modifying the residency to improve
its educational content, particularly in subjects outside of the
operating room. Much of the focus has been on the clinical base
year (CBY). In recent years, the American Board of Anesthesiology
has tightened the CBY requirements, but it continues to take place
outside the anesthesiology department and frequently not even
in the same institution. There is serious discussion about going
from a CBY and three years of clinical anesthesia to four years
of training in anesthesiology. This will cause some dislocations
and difficulties but is likely the only avenue for substantial
change in the residency.
The next area is how well we "experienced anesthesiologists"
keep up with the current body of knowledge. The American Board
of Medical Specialties (ABMS) is mandating that all its member
boards (including the American Board of Anesthesiology) adopt
a system of Maintenance of Certification (MOC). Maintenance of
Certification will be required of diplomates with time-limited
certificates and optional for those with a permanent certificate.
MOC will be based on four elements: 1) professional standing demonstrated
by an unrestricted medical license, 2) practice assessment, 3)
a secure examination and 4) a commitment to lifelong learning
and involvement in periodic self-assessment. ABMS has suggested
that certifying boards and their respective specialty societies
form partnerships to develop lifelong learning programs. To that
end, ABA has formed the Council for the Continuous Professional
Development of Anesthesiologists (CCPDA). The purpose of CCPDA
shall be to develop and maintain a lifelong learning and self-assessment
curriculum and to describe the content of programs, courses and
other educational activities that will satisfy the curricular
requirements for maintenance of ABA certification. Two members
of CCPDA are ASA representatives.
Individuals and organizations have to make choices and set priorities.
ASA has been forced to pay attention to global issues. However,
the quality of future anesthesia care will likely be more dependent
on our efforts in improving research, resident training and continuing
medical education.
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