ow can such a remote issue, considered by many to be the province of chiefs, professional and administrative leaders and others whose hair (if any) is turning gray, possibly be of any interest to a resident?

How does SGR affect MAC or CMS modify the train-of-four response?

What are governmental affairs anyway — clandestine meetings between governmental employees?

Governmental affairs are to your professional career as your IRA is to your retirement income. It is an essential part of your career both for patients for whom you advocate and for yourself. It needs tending early, often and on a regular basis. The rewards are rarely immediate but rather represent an accumulation of work and effort over the long term. Most importantly, the earlier you make the investment of your time and effort, the greater the potential rewards.

The federal government directly represents more than 30 percent of the patient population who comes to the operating room, primarily Medicare and Social Security dependents. Everyone is aware that the baby boomers are closing in on eligibility for Medicare and that this percentage will increase dramatically. State government is responsible for Medicaid (with federal support) and workers’ compensation programs. Both these legislative bodies may impact the commercial insurers and the anesthesiology practice environment. Many payers inappropriately key their reimbursement rate to the Medicare rate. The state plays a critical role in determining multiple other areas such as scope-of-practice issues, mandated benefits and even taxation on practice income. Even though you may look to a future career in independent private practice, the reality is that much of your practice will be controlled by government agencies.

Why is 30 percent an important number? Attend a presentation by Alexander A. Hannenberg, M.D., ASA Vice-President for Professional Affairs, describing the impact of the increasing Medicare population on practice revenue.

Despite an appearance to the contrary, the government is not a bottomless pit of funds. Many different and divergent groups are fighting for the federal and state dollar, with each group being very committed to its own cause. The legislators will have their own particular priorities that do not necessarily reflect your priorities. There is competition within the health care field (such as long-term care or acute care), within the profession itself (such as oncologists or emergency room physicians) and even within the specialty itself (such as the ongoing issues between nurse anesthetists and anesthesiologists). With all these competing forces, it should be very obvious that if you are not there making your case, at best you are uninformed as to how the world works and at worst, you do not care about your patients, your chosen profession or yourself.

Each individual has his/her strengths, so it is neither necessary nor desirable to have everybody stalking the corridors of power. Everyone, however, should have an understanding of the impact of federal and state actions on all aspects of health care, right from the general picture, such as what percent of the gross national product is consumed by health care (15 percent), down to whether an arterial line is a bundled procedure. With understanding should come tangible support, including such direct actions as responding to a call to action by writing or calling a legislator or agency and contributing to a political action committee(s) on a regular (annual) basis. Indirect actions, such as supporting the individuals who are actively advocating your cause by facilitating coverage of clinical work when they have to be away at legislative hearings or similar, are equally important. Lobbyists and other agents of the organization can achieve much of the background work, but at certain times, it is critical that key individuals be present in person. That person needs to be able to show that he/she represents a significant number of the group. For example, a 10-percent PAC participation rate does not reinforce the point that there are important issues facing the medical community; rather it suggests that both status quo and proposed developments are acceptable.

The group that should be the most concerned about governmental affairs is the residents. They have the most to gain as well as the most to lose. Most legislators take particular interest in what younger physicians perceive as important. Younger physicians may not necessarily have the historical perspective, but to some extent, this is irrelevant because what is going to happen in the future is the real concern. Future obligations are of greater importance than past achievements. Not least of all, many legislators will look to these young physicians for their own health care as well as potential long-term supporters as they advance their careers.

So what does governmental affairs encompass? It covers a wide spectrum of activities, but at its base is an interest in what is happening outside the operating room. It starts at the local level. Serving on facility committees or task forces, attending staff meetings and being an active member of the department are all elements of importance for finding out about what is happening as well as building the contacts and networks necessary to achieve goals (or prevent adverse events) at a later date. Unfortunately some anesthesiologists are sometimes perceived to be more interested in when the case will end and when they can leave rather than the corporate issues of patient care.

Expand on your facility activities by becoming involved in local community issues. To many patients, physicians’ reimbursement is perceived to be the primary cause (and an easily correctable cause) of rapidly escalating costs of health care. If you are a recognized participant in local community activities such as sports, school or town affairs, you are much more likely to have a sympathetic hearing. Finally, become involved with your professional organization, especially the state component. Attend the meetings, serve on a committee, become an active participant. The ASA Washington Office is an excellent resource for information and other advice on governmental affairs and related issues.

Well, what has the Resident Component already done? Over the last few years, under the active leadership of the chairs of the Resident Component, the involvement of residents in governmental affairs has increased markedly. The most noticeable event has been a dramatic increase in the number of residents attending the ASA Legislative Conference in Washington in early May. The goal is for a resident from every state to be present with more from some of the larger programs. This is an excellent opportunity to get a head start on governmental affairs. The Resident Component is seeking to sponsor its own regional practice management program after a successful introduction at the Resident Component House of Delegates during the ASA 2005 Annual Meeting. Many of these issues directly relate to governmental affairs. There are resident members on many ASA committees, and residents also are represented on the Board of Directors. Even though this is within the specialty, it still represents an element of governmental affairs. There also is representation to the American Medical Association by several anesthesiology residents.

With all of the opportunities, with all of the work that has already been done, with all of the potential benefits and with the need to prevent the marginalization of the practice of anesthesiology, both the need and the opportunity to be an active participant have never been greater.

Richard M. Flowerdew, M.B., is Attending Anesthesiologist, Maine Medical Center, Portland, Maine.