Daniel M. Thys, M.D., President
Association of Anesthesiology Program Directors

Lydia A. Conlay, M.D., Ph.D., President
Society of Academic Anesthesiology Chairs

he 2004-05 year for SAAC/AAPD began with its Annual Meeting held on November 5-7, 2004, in Boston, Massachusetts. The meeting followed the format of prior years’ gatherings. It included a presentation by ASA President Eugene P. Sinclair, M.D., as well as reports from the Accreditation Council for Graduate Medical Education (ACGME), the Residency Review Committee (RRC) for Anesthesiology, the American Board of Anesthesiology (ABA) and the ABA-ASA Joint Council on In-training Examinations. Panels focused on financial issues in academic departments, faculty development, the ACGME outcomes-based project, anesthesiology workforce issues and the importance of quality in academic practices. A significant portion of the meeting was dedicated to the RRC’s proposed revision of the program requirements and the four-year curriculum in anesthesia. Lively discussions surrounded this topic.

At the business meeting, the organizations’ members elected the following new officers: Daniel M. Thys, M.D., AAPD President; M. Christine Stock, M.D., AAPD President-Elect; and Jeffrey L. Apfelbaum, M.D., SAAC/AAPD Secretary-Treasurer. Lydia A. Conlay, M.D., Ph.D., succeeded Philip G. Boysen, M.D., as SAAC President. Members newly elected to the council included James E. Cottrell, M.D., Alex S. Evers, M.D., and Berend Mets, M.B., Ch.B., Ph.D.

A new program element was a “Special Session for New Chairs and Program Directors,” held immediately before the start of the Annual Meeting and featured a number of well-established chairs as well as a medical school dean (Joseph G. Reves, M.D. Medical University of South Carolina). The session was open to all attendees, but it was primarily designed for new chairs, acting chairs, interim chairs and new program directors. The participants were introduced to the organizational history and structure of SAAC/AAPD and especially to the numerous pitfalls that the new leader of an academic anesthesiology department may encounter when assuming the chair’s position. Evaluations for this session were excellent. Since the annual turnover rate for anesthesiology chairs and core program directors still hovers in the range of 20 percent, it is likely that presentations of this nature will continue to be of interest to the membership and included in the program. In addition, a new initiative will be implemented for the 2005 meeting. Academic anesthesiologists who have been recognized as prospective departmental chairs will be invited to attend the Annual Meeting as space allows.

Primer for Program Directors: To respond to another educational need, SAAC/AAPD organized a workshop titled “A Primer on Accreditation for Program Directors” that was held in conjunction with the 2005 ASA Annual Meeting in Atlanta on October 24. For many years, the only anesthesiology program directors were the directors of the core anesthesiology programs. Over the past decade, however, programs also have become accredited in subspecialty areas such as intensive care, pain management and pediatric anesthesia. Cardiac anesthesia will soon follow this lead. The result is a large number of new anesthesiology program directors. While each of the subspecialties has its own program directors’ association, there has not necessarily been a uniform exposure to issues of interest to ACGME, such as the teaching of the competencies. Thus SAAC/AAPD organized a workshop to address this topic. Participants from ACGME included Barbara Joyce, Ph.D., and Judith Armbruster, Ph.D., Executive Director for the RRC in Anesthesiology. Mark A. Warner, M.D., represented the RRC while Steven C. Hall, M.D., represented ABA. Topics included an overview of the accreditation process; advice on preparing the Program Information Form (PIF), the report which provides the information necessary for a program’s accreditation; tips on how to be a successful program director; and a practical approach for teaching the competencies. Program directors from both the subspecialties and the core programs were invited, including those for adult and pediatric cardiothoracic anesthesia, since those subspecialties are likely to be accredited by ACGME in the near future.

SAAC/AAPD and Substance Abuse: While substance abuse is a problem that is certainly not limited to anesthesiology, its effects on members of our specialty have been devastating. In the early 1990s, SAAC/AAPD sponsored the creation of an educational video program called “Wearing Masks.” It was widely distributed within the anesthesiology training community and utilized by many programs for the education of residents and their families. In 2004, the leadership of SAAC/AAPD concluded that it was time to update the educational offering and to expand it to include additional topics such as the science of addiction, the consequences of substance abuse on anesthesiology departments, possible responses and the impact of newer agents that may be abused, such as sevoflurane and propofol. Under the leadership of Philip G. Boysen, M.D., a DVD titled “Collateral Damage: Drug Abuse and Anesthesiology” was funded and produced by SAAC/AAPD; it has been distributed to all anesthesiology residency programs. The DVD also has come to the attention of ASA’s leadership, and the potential for its broader distribution within the anesthesiology community is being evaluated.

Academic Programs: The one issue that has required the greatest involvement by SAAC/AAPD leadership over the past year has been the RRC’s proposed revision to the program requirements for anesthesiology. After ACGME failed to approve the RRC’s proposed revisions for residency training in February 2005, SAAC/AAPD immediately offered to work with the RRC in its efforts to revise the program requirements. SAAC/AAPD embraces the RRC’s objective to adjust anesthesiology training so that graduates are better prepared for a changing future. It also is mindful, however, of the fact that many academic anesthesiology departments continue to face significant challenges such as faculty shortages, high chair turnover, financial difficulties, etc. A very positive and fruitful dialogue is ongoing between the RRC and SAAC/AAPD, and we are optimistic that additional proposed revisions to the program requirements are likely to be approved by ACGME and implemented in 2006.

Medicare’s Reimbursement for Teaching Physicians: A second item of vital importance to anesthesiology training programs is the revision of the Medicare Teaching Rule, which is uniquely applied to anesthesiology. While a teaching anesthesiologist’s fee is cut by 50 percent for even a one-minute overlap of covering two cases, a surgeon can simultaneously run two operating rooms and an internist, four examination rooms and still receive a full reimbursement for each. This disparity for training programs is magnified because academic medical centers care for a disproportionate share of patients covered by Medicare, Medicaid and those who are unable to pay at all, and because both Medicaid and now several commercial carriers are increasingly applying the Medicare teaching rules for departmental reimbursement. According to a survey of SAAC/AAPD members performed by Kevin K. Tremper, M.D., Ph.D., no academic anesthesiology departments can currently “break even” on clinical revenues alone. Moreover the average stipend required for academic anesthesiologists last year had risen to $112,000 per faculty full-time equivalent! Such support is not without “strings,” and we have observed a number of issues that may well be related to the dire financial straits that academic departments face today.

Achieving parity with other specialties has been a significant challenge, particularly since some providers no doubt prefer that rules for anesthesiologists resemble those for nonphysician providers rather than those for our physician colleagues in other specialties. SAAC/AAPD is very grateful for the support and interest that ASA and its leadership have shown on this issue and in particular for the assistance from Alexander A. Hannenberg, M.D., and Norman A. Cohen, M.D., as well as the ASA Washington Office.

Hurricane Katrina: As soon as the devastating impact of Hurricane Katrina on the Gulf Coast and its health care facilities became clear, SAAC/AAPD began exploring opportunities to assist the residents of the two New Orleans-based anesthesiology training programs. The original plans called for Tulane University residents to relocate to programs in Houston, while Ochsner Clinic residents would remain at their home institution. To get a better sense of all available options, anesthesiology programs were asked to indicate whether they would be willing and able to accommodate residents from New Orleans. The responses were overwhelmingly positive, and a long list of available positions was developed and forwarded to ACGME. SAAC/AAPD intends to work with other anesthesiology organizations in the development of contingency plans for future disasters. For Katrina, good will was abundant within the academic community and from the private sector as well.

Lydia A. Conlay, M.D., Ph.D., is Professor and Chair, Department of Anesthesiology, Baylor College of Medicine, Houston, Texas.