Cold, Hard Facts: AMA Has Turned Away

Dr. Bacon, I was amused by your recent missives in our April 2004 NEWSLETTER touting the merits of “AMA membership for ASA members.” Notwithstanding some interesting distant history and your invocation of an ancient guilt trip, it is hard to see the contemporary American Medical Association (AMA) as a stalwart defender of the interests of anesthesiologists. While many other examples abound, I offer the following information:

The Medicare “allowable/charged” ratio is absolutely the lowest for anesthesiologists among all medical specialties. Simply restated, Medicare pays a higher percentage of the bills from every other specialty when compared to anesthesiologists. That hardly sounds to me like AMA has been looking out for our specialty’s best interests. In fact we are remarkably lower than many other specialties, receiving only about half the average for all specialties! In the current zero-sum game of Medicare funding, AMA and other specialties are balancing their budgets on our backs! Some allies.

The data supporting my disturbing statement come from Physician Practice magazine in its April 2004 edition. The data were lifted from the public records of Medicare. Physician Practice assembled these data to complain about the high incidence of “rejected claims” across all specialties. By simply taking a ratio of “allowed charges per billed charges,” however, one can see where we stand as anesthesiologists in the Medicare food chain: dead last. I have attached the data table from Physician Practice. The last column is my additional analysis. If these numbers are wrong, please offer me a better source of data.

To my ear, these data hardly speak well for the advocacy of our interests by AMA. Frankly it speaks poorly for any of our advocacy groups! Thoughts?

Carlton Q. Brown, M.D.
Great Falls, Virginia

Editor’s Note: Dr. Brown, I agree with your data (copies available from Dr. Brown). Why would AMA want to look out for a specialty that doesn’t participate? If we are not in the forefront of AMA politics — and to get there we need members, for AMA representation is based upon the number of AMA members within a specialty — we will be forgotten. Now that there is an anesthesiologist within the highest councils of AMA, hopefully some of these past wrongs will be righted. As for the ancient guilt trip, the argument can be strongly made that ASA would not have existed had not AMA encouraged the formation of the American Board of Anesthesiology. Therefore, by logical extension, this discussion would not take place, and you and I, Dr. Brown, would most likely not be anesthesiologists!

— D.R.B.

Locum Tenens Article Is Loco

An evolving paradigm in the provision of anesthesiology services in America involves the extensive use of locum tenens physicians. An overall personnel shortage, coupled with a distribution of providers skewed toward urban centers and their surroundings, has left many practices permanently shorthanded. With too few hospitals and ambulatory surgical centers announcing open bidding for exclusive anesthesiology contracts, well-trained and highly motivated entrepreneurs like myself have capitalized on this nationwide regional supply/demand mismatch by establishing locum tenens practices. I am far from being alone.

By choice, the last four years of my 11-year career in anesthesiology practice has been the exclusive provision of short-term locum tenens services, frequently interspersed with vacation time. My locum tenens career, which I consider to be very rewarding, consists of jumping from job to job with short stints here and there (two or three weeks here, a week there, a couple of weeks off, four weeks here, a week there).¹

Using a broad brush, Ms. Bierstein, in her May 2004 “Practice Management” column, painted a very unflattering picture of locum tenens anesthesiologists. The statement, “Those who are career locums with short-term assignments generally have one or more of the following issues: personality/attitude problems, substance abuse issues or clinical shortcomings,” is prejudicial. Although Ms. Bierstein’s source may have some anecdotal reports to support this blanket indictment, the manner in which it was presented may lead some to inappropriately consider this personal opinion to be the official ASA position.

I have neither surveys nor statistics to rebut the assertion that people who want to do locum tenens work full time generally want long-term assignments to avoid the hassles of looking for good assignments and avoid the uncertainty of where their next paycheck is coming from.¹

What I do have is the camaraderie and concurrence of dozens of fellow locum tenens providers I’ve met, who like myself, thoroughly enjoy experiencing different regions and practices. The absolute length of any given contract has significantly less importance to us than being both treated fairly and compensated adequately.

Because some who have hiring authority or regulatory control may consider the opinions presented in Ms. Bierstein’s column to be convincing, the livelihoods of competent, congenial locum tenens anesthesiologists such as myself could potentially be jeopardized or undermined. Therefore to be fair and balanced, a clarification of the statements found in Ms. Bierstein’s column in the next issue of the ASA NEWSLETTER is absolutely necessary.

David Breznick, M.D.
Iron Mountain, Michigan


Reference:

1. Bierstein K. Locum tenens & Stark II rules. ASA Newsl. 2004; 68(5):28-29.


Editor’s Note: We are pleased to publish Dr. Bresnick’s comments on locum tenens providers. The introduction to Ms. Bierstein’s column made it clear that it was written by a guest author not employed by or affiliated with ASA, who in the introduction confessed that his “missive here is probably a little bit exaggerated.”

— D.R.B.

Old Is as Old Does

The June 2004 issue featured an effort to evaluate “Aging Anesthesiologists,” presumably to prevent these dinosaurs from committing mayhem on the unsuspecting public.

In June 2005, I will celebrate my 50th year in the practice of anesthesiology. After 30 years of hospital-based practice, I turned toward greener pastures in sunny Florida where I have practiced solo as anesthesiologist-in-charge of an ambulatory eye surgical center. My mind is keen, my hand is steady, and I routinely perform topical-mac, retrobulbar and propofol anesthesia for a demanding eye surgeon as well as an occuloplastic surgeon who also is board certified in head and neck.

My only point is that retiring from practice is not a simple matter of cognitive and manual skills. The prudent physician will recognize his or her shortcomings, while the active mind refuses to give in to golf or fishing as long as his or her performance meets the stringent requirements of modern surgery because there is both a self-fulfilling as well as a monetary reward for the continuance of honed skills. I plan to retire on my 50th anniversary. Enough said.

Burton Rubin, M.D.
Alva, Florida

American Idle

The negative views expressed by Tamar F. Singer, M.D., with regard to ASA’s support of the American Medical Association (“Letters to the Editor,” July 2004 NEWSLETTER) and her wholesale rejection of that organization were disconcertingly reminiscent of the citizen who gripes about politics yet does not vote. To be an American physician is to be among the most fortunate and potentially influential of people. And so I would hope that Dr. Singer (and her reportedly many medical friends) might choose to use her station and “voice” wisely in order to make a positive difference in American medicine. Join, participate … then grumble.

Perry G. Fine, M.D.
Salt Lake City, Utah

Board-Certification Article Doesn’t Pass Examination

The article in the August 2004 ASA NEWSLETTER by Scott M. Fishman, M.D., titled “The Future of Training and Education for Pain Medicine” contained several incorrect assertions and led readers to reach invalid inferences. My purpose in writing is to correct the record about these matters.

Anesthesiologists, neurologists, physiatrists, psychiatrists and scientists from nonmedical disciplines collaborate to develop one pain medicine examination annually under the guidance and direction of an American Board of Medical Specialties (ABMS)-approved Joint Pain Medicine Examination Committee. The National Board of Medical Examiners provides editorial, test development, psychometric and other services for the Joint Committee. Committee members participated in a study, designed and conducted by National Board of Medical Examiners (NBME) psychometricians to set one criterion-based standard for the examination.

The Joint Committee, in conjunction with NBME, develops a pain medicine subspecialty certification examination annually that is psychometrically valid and practice-related. Every candidate for certification in pain medicine by the American Board of Anesthesiology or another ABMS member board, regardless of her or his primary training specialty, takes the same examination and has to meet the same criterion-based passing standard.

Patricia A. Kapur, M.D.
ABA Secretary