Douglas R. Bacon, M.D., Editor

February Blues

ebruary is a tough month. The cold and dark of winter are still upon us. The urge to stay in a warm bed and not exert beyond the bare necessities of what is needed to meet expectations is almost overwhelming. The snooze alarm is both a friend and a foe. My son’s early morning practices — where he has to be on the ice in full goaltender equipment at 5:30 a.m. — have created a new meaning for the word “commitment” for me. My grandmother always said, “If you can make it through February, the rest of the year is easy.”

So where are we as anesthesiologists as February dawns? The Bush Administration has been returned to Washington, which means that we are working with many well-known faces. The agenda should be clear in front of us. ASA members are writing reports to be discussed at the Board of Directors. Plans are being made for the Annual Meeting and centennial celebration in New Orleans, Louisiana. Business as usual, correct?

No, for today, at this very moment as you read these words, your voice is needed. Ann Landers was famous for saying “wake up and smell the coffee,” but in our case, the pot has overflowed, and the pleasant aroma has been turned into burned ugliness. The specialty is facing many crises and, therefore, offers many opportunities to improve and change. But it cannot be done without you.

Let us start within academic anesthesiology. There is a tremendous problem with reimbursement within the academic community. The Medicare rule, which gives partial payment for services rendered when anesthesiologists are supervising two residents, is both impractical and unfair. Surgeons are under no such penalty. Among those who have seen the light on our issue is Senator Hillary Clinton, whom I am very pleased to say is active in positive reinforcement with us on this issue.

Why should you care? Academic departments are in financial trouble. In a few short years, training of new physicians in our specialty may well have to be curtailed. If we as a specialty lose the ability to replace ourselves, let alone expand services, our specialty will be dead within one generation. Is this a crisis? Yes, but it also is an opportunity. We have the chance to redefine our academic mission and to encourage the people in power in Washington and within the Medicare administration — but more important, outside in the House of Representatives, the Senate and indeed the White House itself — to understand the importance of our work. It only requires that we stand up and be counted by doing something as simple as sending an e-mail.

Politics, especially the politics of reimbursement, turns off many anesthesiologists. Yet there is a greater challenge before us. In the “Letters to the Editor” section of the December ASA NEWSLETTER, Michael H. Entrup, M.D,¹ describes the reaction of his fellow hospital board members when he arrived in a suit to his first meeting. He further relates how a surgeon finally came to view him as a “real doctor.” I would argue that the problem is not with Dr. Entrup specifically but rather with our usual behavior.

As anesthesiologists, we are not visible unless there is a crisis. We do not do the little things that make people aware of our specialty on a daily basis. Brett J. Halloran, M.D., is right when he was concerned that an anesthesiologist was not part of the team that met the press after former President Clinton’s heart surgery.² Like good defense in ice hockey, where the puck is knocked off a stick before a pass is made, thus stopping the offense cold, anesthesiologists in their day-to-day practice work hard at being unknown. Impossible conventional intubation? No real problem, we’ll just fiberoptically intubate the patient, and the case continues as if nothing extraordinary had occurred. Invasive monitoring allows anesthesiologists to manage almost every physiologic parameter imaginable. There are very few intraoperative deaths, but often the real question is not whether the patient will get out of the operating room alive but whether they will ever leave the intensive care unit.

Recently there has been a cry, a voice in the wilderness, if you will, saying that anesthesiology is in crisis and will disappear shortly, supplanted by cheaper providers. Each year there is a new issue with the word “crisis” closely attached. In the 1960s, it was a workforce crisis. In the 1980s, it was a legal crisis. I would argue that the crisis we face today is not issue-specific; it is a participation crisis.

Let us look for a minute at the ASA Political Action Committee (ASAPAC). About 10 percent of all ASA members contribute to ASAPAC. This money is used to help elect officials that are empathetic to our cause. That we have to “buy” our way into politician’s offices is an unfortunate reality of 21st century American democracy. But think for a moment about how far we would go if 50 percent of anesthesiologists gave money to the PAC. What commitment is involved? The simple writing of another check while paying bills?

Outside of national participation, where else are anesthesiologists needed? Dr. Entrup’s letter makes a strong point that we are needed not only nationally and at the state level, but also in our own local hospitals. How many anesthesiologists are chiefs of staff of their respective groups or the medical staff? Committee work is often long, dull and boring. It takes commitment to get to the committee meeting after a long day in the operating room, intensive care unit or pain clinic. Yet by showing up, we further the specialty. One of our residents coaches young women’s soccer. He has been asked more about anesthesiology on the practice field than he has in the preoperative assessment clinic. Community involvement is equally as important as professional society involvement. If the general population knows about us, then we shall succeed despite all the policies ever written.

Recently my son’s coaches talked about being scored upon and losing the hockey game. It is not the goalie’s fault, although the goalie is the last line of defense for the team. It is not the defense’s fault, or the forwards’. Individually no one is to blame — it is a team responsibility to keep the opponents off the board. Our biggest crisis in anesthesiology is participation. We need you on our team. Will you come and help us build a better specialty for the future — our future and for those who come after us? The puck is squarely on your stick.

References:

1. Entrup MH. Insult or compliment? ASA Newsl. 2004; 68(12):40-41.

2. Halloran BJ. Missed opportunity for spotlight in Clinton surgery. ASA Newsl. 2004; 68(12):40.

return to top