A Letter of Recommendation to FAER

From time to time, the Foundation for Anesthesia Education and Research (FAER) receives correspondence from leaders in clinical anesthesiology that discusses issues relevant to all practicing anesthesiologists. Many of these notes are encouraging to FAER vis-à-vis our programs aimed at improving the science of anesthesiology through investing in new research and education.

FAER President Alan D. Sessler, M.D., recently received a letter from Thomas R. Hill, M.D., of Hickory, North Carolina, describing circumstances of concern to all anesthesiologists regarding other professions encroaching on the specialty of anesthesiology.

We reprint the following excerpts with permission from Dr. Hill and with appreciation for the perspective as well as the encouragement and support. FAER designs its research and education programs to produce leaders who are readily identifiable as professional physician anesthesiologists.

FAER greatly appreciates the contributions made by Dr. Hill and reiterates its commitment to continue investing in the future researchers and educators of anesthesiology. By working together, private-practice and academic departments can provide a pathway to sustained professional credibility.

Dear Dr. Sessler,

I have now heard it said in my hospital, by four general surgeons, three emergency medicine physicians and two cardiologists:

“Gee, anesthesia is so safe now, if JCAHO didn’t make us live by these guidelines for sedation, anybody could give anesthesia.”

“Anybody could give anesthesia.”

Advancements over the last two decades are truly a double-edged sword for our profession. Improvements in the delivery of anesthesia and the safety and aesthetics of peri-procedural care have generated an attitude among surgeons, internists and other specialists who perform procedures that anesthesia is simple — just have someone watch the airway. Not only is this flippant attitude apparent in physicians, but in nursing and allied health professionals also. Currently respiratory care professionals are expanding their scope of practice in North Carolina to include moderate sedation for a variety of procedures and during the transportation of patients. EMT/paramedics are expanding their formularies to include ketamine, intermediate-acting neuromuscular blocking agents and fentanyl citrate for “procedures on board the ambulance.”

I hope I’m not the first anesthesiologist to implore that the direction for anesthesia education and research must focus on developing a knowledge base of how our advances in pharmacology and technology impact outcome and the future of our specialty in delivering care throughout all practice venues.

As a practitioner in a hospital setting where the team approach is employed, a member of the county EMS advisory council, a part-time clinical faculty member at Wake Forest University who trains anesthesiologists and nurse anesthetists and a member of the leadership of our state society, I find myself constantly defending my existence. Everyone else can do my job, until the job becomes dirty: postdural puncture headaches, bruised lips, class IV Mallampati airways and alcohol-intoxicated trauma victims. Then “call anesthesia.”

Please find enclosed a check for $1,000 to support education and research in anesthesiology. I will be anxious to hear of projects and educational media that reflect the vital nature of our care as physicians.

Sincerely,

Thomas R. Hill, M.D.
Staff Anesthesiologist, Catawba Valley Medical Center,
Clinical Assistant Professor, Wake Forest University/Baptist Medical Center
Secretary-Treasurer-Elect, North Carolina Society of Anesthesiologists

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