For the past two years, I have had the unique honor and distinct privilege to serve as an officer of ASA and a member of the Executive Committee.

I have had the opportunity to work with two outstanding ASA Presidents, Barry M. Glazer, M.D., and James E. Cottrell, M.D.

They have tried their best to take this country doctor from the Blue Ridge Mountains of southwest Virginia and impart something “presidential” to him.

We shall all find out shortly if they were successful.

During this same period of time, I have traveled the width and breadth of this great land with my wife, Ona, at my side. In every instance, you have received us warmly, and I thank all of you for your hospitality.

I have spoken with ASA members in their home states. I have heard things that have made me proud.

I have heard things that have made me sad.

I have found ASA members to be compassionate physicians who are committed to the safe care of their patients.

I have found that ASA members are concerned about their continued ability to provide this care because of the many challenges they face each day.

I have found that ASA members are frustrated in their ability to address these challenges by a tangle of bureaucratic regulations and red tape in an increasingly hostile medical liability climate.

Yet I am pleased to report to you that today ASA stands strong.

ASA is strong because it represents the best specialty in medicine.

ASA is strong because of its continued support of research in its funding for the Foundation for Anesthesia Education and Research.

ASA is strong because of its continued support of safety in its funding for the Anesthesia Patient Safety Foundation.

ASA is strong because it remembers its heritage in its continued funding of the Wood Library-Museum of Anesthesiology.

ASA is strong because it continues to gain members annually when many professional societies each year face a reduction in their membership.

ASA is strong because its members are willing to give unselfishly of their time and energy to do the work of ASA committees and task forces.

ASA is strong because it is an organization of compassionate young physicians who care deeply about their patients and who have most of their careers ahead of them.

ASA is strong because it is fiscally sound.

ASA is strong because of each and every one of you in this House this morning. You are the delegates of the ASA. You represent its strength. I salute each of you.

ASA is strong because of the excellent staff it has in Park Ridge, Illinois, and Washington, D.C. Our new Executive Director Ronald A. Bruns has continued the excellent work of his predecessors. Michael Scott leads a team in the Washington Office that continues to make our presence known on Capitol Hill and is the envy of other medical organizations. I thank you, Ron. I thank you, Mike. I thank each of the ASA staff for the work they do, for they enhance the effectiveness of my work each day.

This morning I want to talk with you about three words: compassion, science and involvement.

King Solomon, thought by many to have been the wisest man who ever lived, said, “Where there is no vision, the people perish.”

This morning I want to share with you my vision for ASA for the year ahead because it will be my responsibility to lead you.

My vision for ASA is that it will grow as a Society of physicians and scientists who are driven by compassion and guided by science to provide the best and safest patient care.

That, in addition, its members will come to understand that to achieve this mission there must be involvement in the political process that has come to define how medicine is practiced in this great land.

A simple vision, and therein lays its complexity.

Compassion, science, involvement — three rather simple words, yet these three words define the essence of a physician.

Compassion is the first part of my vision for ASA.

Compassion is a quality that every physician must possess.

Compassion is what causes us to place our patients ahead of ourselves.

Compassion is what drives us to spend long hours helping to alleviate the pain and suffering that confronts us daily.

Compassion is what causes us to gently hold the hand of an anxious patient.

Compassion is what drives us to study the sciences to better prepare ourselves to care for our patients.

And compassion is what forces us to be involved in the processes that control and define our ability to care for patients.

The second part of my vision requires that our science be strong and be a guiding light. We are in danger here! There is trouble in our academic programs. These are the very programs that are the source of our science. These are the very programs that are training the next generation of anesthesiologists.

Increased clinical loads and decreased payments jeopardize research and training. The number of research-funding grant applications from academic anesthesiologists is decreasing. The number of scientific submissions to our journal Anesthesiology is decreasing. This is occurring at a time when the brightest and best medical students are again choosing anesthesiology as their specialty. We must not let these young physicians down.

Fair payment for the care and teaching that academic anesthesiologists provide must be forthcoming if our academic programs are to survive. If our academic programs fail, our specialty is one generation away from extinction, and the safety of our patients is in jeopardy!

The problem of fair payment for services rendered is not a problem unique to our academic programs. Every anesthesiologist faces increasing practice costs with decreasing practice income.

The reasons for these increased costs are known. The federal government continues to increase the number and complexity of the regulations which govern our practices while at the same time it decreases the amount of payment we receive for the care we render our patients. Third-party payers are quick to try to benchmark their payments to those of the federal government.

The medical liability crisis continues to worsen. Medical liability insurance companies continue to increase their premiums for the insurance we must have. Tort reform remains elusive in many states. The United States Senate refuses to believe that this is a crisis that deserves a solution.

The resolution of these problems lies not in a scientific discovery or in research but in the arena of politics. Politics is the antithesis of science.

Now we have arrived at the third part of my vision for ASA: involvement in the political process. I fear this part of the vision will be much harder to accomplish than the first two parts of my vision.

Involvement in the political process is necessary for our survival now and for the foreseeable future. Sadly, ASA members are not involved in the political process as much as they should be.

Let me cite three examples.

ASA members were asked early this year to contact their members of Congress to express concern about the projected 4.5-percent decrease in Medicare payments to physicians. Less than 10 percent of ASA members responded. Recently ASA again asked for you to contact your members of Congress to express concern about a 4.5-percent decrease in Medicare payment scheduled for January 1, 2004. This time the response has been worse than it was earlier in the year!

When the Senate considered a cloture vote on debate of the Senate bill on tort reform, ASA members were asked to contact their Senators and ask them to support the cloture vote. Less than 10 percent of ASA members responded.

When the ASA Political Action Committee (ASAPAC) 2003 year ended at the end of September, less than 10 percent of the ASA members were ASAPAC contributors.

Like many of you in this House, I am a fan of the great game of college football. Yesterday my Virginia Tech Hokies defeated the Syracuse Orangemen by the score of 51-7. My apologies to those of you from New York. Virginia Tech won yesterday because the whole team showed up to play. No college football team has a chance of winning a game if less than 10 percent of the team show up for game day. Our situation is no different.

We will not be successful if our involvement in the political process continues at the present level.

Aristotle said, “Man is by nature a political animal.” What is clear to me is that Aristotle never met a physician, at least not a 21st century physician who was an ASA member.

Ronald Reagan said, “Politics is supposed to be the second oldest profession. I have come to realize it bears a very close resemblance to the first.” Perhaps that explains why so many physicians are uninvolved in the political process today.

Politics is simple. It’s all about participation, money and votes. It requires nothing more, and it will settle for nothing less. In short, it requires involvement!

This morning I ask for your help when you return to your component societies and your local practices. Be a leader in helping your colleagues to understand this fundamental truth.

Our compassion will not save our specialty.

Our science will not save our specialty.

When our income and our expenses are equal, we are out of business. For some of us working with large numbers of federal- and state-insured patients, we are almost there.

If we do not get our involvement in politics right, our compassion and science won’t matter. We will cease to exist.

The problems that acutely threaten our survival have solutions in the political arena.

The message I ask you to take home is simple and yet profound:

IF WE AS PHYSICIANS DON’T GET INVOLVED IN THE POLITICAL PROCESS, OUR SCIENCE AND COMPASSION WILL NOT MATTER. WE WILL HAVE CEASED TO EXIST!

Compassion, science, involvement — three rather simple words, yet these three words define the essence of a physician.

Beginning this afternoon, this House will address many important issues in its four Reference Committees. Some of these issues are contentious. Debate fully the merits of each issue, and in the end, let civility and consideration for the patient be the principles that guide your decisions. I want to remind each of you that people of good will can disagree on issues without becoming disagreeable.

Of the many important issues you will debate in the next few hours, there are several I want to call to your attention.

Carefully consider the reports that cover the area of the ASA’s expert witness review program.
I urge you to approve this program and by so doing establish this important process for ASA. We must be willing to police ourselves.

Even before your approval of the ASA program, the trial lawyers have noted our move toward such a program in articles in the July 6, 2003, New York Times and the July 7, 2003, National Law Journal.

Trial lawyers are not happy, and this is a good thing!

At the Interim Meeting of the Board of Directors, Report 400-3.1 was approved. This report creates an educational membership for nurse anesthetists. I urge your approval of this Board of Directors action. It is time that nurse anesthetists who believe in the anesthesia care team have another professional society to which they may belong. ASA should be that society.

There has been much activity surrounding the use of anesthesiologist assistants in the past year. Steven D. Goldfien, M.D., has chaired an ad hoc committee that addressed the potential for additional training programs for anesthesiologist assistants. I ask you to study Report 433-2 closely.

This House has the opportunity to create a position on the ASA Board of Directors for an academic anesthesiologist. In addition it has the opportunity to create a Committee on Academic Anesthesiology. I urge your approval of these important steps as ASA and the academic departments seek to strengthen the ties that bind.

Compassion, science, involvement — three rather simple words, yet these three words define the essence of a physician.

I thank this House for the honor you have bestowed upon me. I am proud to be a physician and an anesthesiologist. The office of President of ASA is much larger than I am. I ask for your support and your constructive criticism. Most of all, I ask for your prayers as I undertake to lead you in 2004. I ask for you to pray for wisdom, knowledge, a humble heart, a teachable spirit and safety as I travel.

I close with a portion of one of King Solomon’s prayers:

“Now Lord God … give me wisdom and knowledge that I may lead … .”

Roger W. Litwiller, M.D., is Chief of Anesthesia Services, Chief of Special Medical Services, Member of the Executive Committee of the Professional Staff and staff anesthesiologist, Carilion Roanoke Memorial Hospital, Roanoke, Virginia.