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September 2002
Volume 66 |
Number 9
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ADMINISTRATIVE UPDATE
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Vigilance, Participation, Professionalism
and Family
Peter L. Hendricks, M.D., Assistant Secretary
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As I sit and think of the continuous stream of trials and tribulations
that face each of us in the practice of anesthesiology, I am reminded
of an old Texas saying, "Cheer up, things could be worse."
I did, and sure enough, they were! It seems that just when one
problem looks as though it is solved, another rears its ugly head.
Frustrating and depressing are hardly able to describe the stress
of our profession. However, the pride in providing care to our
patients and expanding the scientific boundaries of anesthesiology
makes it all worthwhile for most. In the future, if we are to
maximize the pride and lessen the stress, it will require a lifestyle
for each of us that will take more of our time, treasure and talent
than many may be willing to give. It is not a one-day deal! It
is an everyday commitment for the rest of our careers. If we are
not willing to live this lifestyle of Vigilance, Participation,
Professionalism and Family, there are "anesthesia providers"
out there who claim they are every bit as capable and well-trained
as we are. And they want our jobs.
Vigilance is being continuously aware of the big picture
around us – not just in the operating rooms, but the hospital
as a whole (substitute outpatient facility as appropriate). If
we are to survive, we must be aware of and participate in hospital
policies and politics. If the hospital is planning to open up
four new operating rooms, we need to know in advance so we can
have appropriate dialogue in order to form a plan of action. Being
surprised after decisions are made only leads to disaster. A response
such as, "There is no way we are opening four more rooms"
just brings about heated discussions in which battlelines are
drawn and hasty, irrational decisions often are made (such as
designating an outside group to come into the hospital and take
over anesthesia). Furthermore, we are seeing an increasing number
of instances where a group of nurse anesthetists have contracted
with hospitals to provide anesthesia services by hiring anesthesiologists
to "supervise." One of the problems we face in today's
medicine is an increasing number of CEOs and COOs who are under
such pressure to compete for business that the bottom line becomes
the only consideration. The result is that "patient care"
too often takes a back seat. Also compounding the problem is the
fact that the ranks of administrators are getting spread so thin
that your odds of having one who will deal realistically and fairly
with your problems are becoming remote.
There are also a growing number of administrators who seem to
be living in a world of their own with no grip on reality. Case
in point: a medium- to large-sized hospital that for years has
been covered adequately by an anesthesia care team group gets
a new administrator who comes in and says, "In order to compete
and to please my surgeons, it is my decision to have 17 operating
rooms open from 7 a.m. to 7 p.m., and, oh, by the way, I don't
want to pay anything additional. If you don't comply, you are
out!" Given this unrealistic demand, the group felt they
had no choice but to leave. The administrator then offered the
contract to a nurse anesthetist entrepreneur group. In this hospital
and another Alabama hospital where this nurse anesthetist-owned
group has taken over contracts from anesthesiologist groups, they
are offering anesthesiologists highly lucrative salaries, short
time to "partnership" and no corporate administrative
duties. Although there is no hard evidence of substantial hospital
subsidies, doing the math indicates that these hospitals seem
willing to help out financially in a manner not offered to the
anesthesiologist groups.
We must take this mode of business very seriously because the
nurse anesthetists do as evidenced by the business literature
available on their national association's Web site. A piece of
advice – if you find yourself in a war with an administrator,
try to get professional third-party mediation; it often makes
it less "personal." A hard fact: to be vigilant requires
participation.
Participation in the life and politics of our hospitals
is essential. Too often we have the choice of going home early
or staying for a medical staff or committee meeting, and far too
often the answer is, "Oh well, someone will tell me what
went on." The only way to find out about matters that are
vital to our practices is to be a "good citizen," to
serve on committees and task forces and to take an interest in
what happens outside the operating room, even when it is at the
most inconvenient times. Hospital administrators have too often
mistrusted and viewed anesthesiology practices as a hindrance
or roadblock to progress as they see it.
While at times this may be true, most of the time, our differences
are because of our inability to generate additional revenue to
do the job properly, our unwillingness to commit the time and
our frustration over not being given the same consideration as
other medical specialties, especially the surgeons. Even in this
hostile atmosphere, we must strive to educate the hospital administrators
about our unique problems and assure them of our desire to work
with them in finding solutions. Participation does not stop at
the hospital door. We must be active in our medical societies,
locally as well as at the state and national levels. It is essential
that we do everything in our power to be seen in our hospitals,
communities and societies as part of the solution and not part
of the problem. This means participation, participation, participation.
This is not easy, but if we want to be part of the solution that
provides better care for our patients, we must make it a priority
and carry it through with professionalism.
Professionalism is essential to our very existence. In
this area, we can become our own worst enemy. The most successful
and influential anesthesiologists act in a professional manner
to everyone, from their patients to their colleagues to the cleaning
staff. Quite often, we are willing to delegate our responsibilities
to others in exchange for additional time for ourselves. I think
the most egregious area is in our preoperative visits. All too
often the only anesthesia personnel the patient sees is a nurse
anesthetist who tells the patient, "I am responsible for
your anesthesia care, and I will be with you every minute."
Some of us have abdicated the one time we have to let the patient
know we are anesthesiologists who are preparing them for their
anesthetic. Over the last few years, we have been on an expensive
educational mission to inform the public that an anesthetic provided
by or under the medical direction of an anesthesiologist is the
gold standard. What better place to start than the preoperative
visit to assure that later, after the anesthetic, when the question
is asked, "Do you want an anesthesiologist involved in your
care?" the answer is always "yes." Obviously, professionalism
encompasses much more, including safely expediting the operating
room cases, being available throughout the hospital when called
upon, and aiding and respecting our colleagues. The benefits of
hard work and a willingness to help others, especially the surgeons,
do pay off. This was verified a few years back at one of our local
hospitals when the hospital administrator made plans (unknown
to the anesthesiology group) to bring in another group to take
over the anesthesia services. The surgeons (who were informed
prior to the anesthesiologists) then went to the administration
and said this arrangement was unsatisfactory and they wanted "their
anesthesia group" retained. The retention was not without
cost to the anesthesia group as they had to absorb the salaries
of the nurse anesthetists, but the quality of anesthesia was preserved,
and now, after serious negotiations, the group even has a supplement
from the hospital. I use this as an example to show how participation
and professionalism can lead to solutions. Granted, it may not
work every time, but without it, we are guaranteed failure.
Last, but certainly not least, is the importance of the ASA
Family. It continues to distress me when I get an exit
survey saying, "I am giving up my membership in ASA because
I am no longer an anesthesiologist; I am a pain specialist."
Although it is true that all pain specialists are not anesthesiologists,
it is equally true in my opinion that the best pain specialists
are anesthesiologists. It is disheartening to hear the opinion
expressed that ASA has nothing to offer and has done nothing for
the pain practitioners, when as an officer of ASA, I have seen
the Administrative Council, Board of Directors and numerous ASA
committees as well as a major task force working to improve pain
education, knowledge and reimbursement, both on the local and
national levels.
ASA members who practice the specialty of pain medicine are far
from forgotten and provide valuable contributions to ASA. But
this great ASA family is made up of many valuable contributing
parts that allow the Society as a whole to provide benefits to
many by using its strength in numbers and unity of purpose to
achieve patient care and academic, educational, financial and
political goals that would be unobtainable if we were divided.
We are a powerful force for safe patient care! If we remain ever
vigilant to our changing surroundings; participate as "good
citizens" in our hospitals, state and national organizations;
and act in a professional manner toward our patients and all those
with whom we work – then the only way we can lose is by dividing
our family.
Again, I leave you with a quote attributed to Benjamin Franklin:
"Gentlemen, if we do not hang together, we most certainly
will hang separately." May health and happiness be with each
and everyone, and God Bless America.
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