A
Society of 40,000 — An Army of One
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Mark J. Lema, M.D., Ph.D.
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 SA
recently reached a historic milestone by topping 40,000
members. I cannot imagine that Adolf F. Erdmann, M.D.,
and his eight colleagues had any clue that their special
interest society in 1905 would evolve into one of
the most influential medical specialties of the 21st
century. Organized anesthesiology has pioneered changes
in medical practice as diverse as critical care, pain
medicine, respiratory care, patient safety and even
cardiopulmonary resuscitation. Anesthesiologists supervise
or personally administer approximately 90 percent
of all anesthetics delivered in the United States.
Our delegation in the American Medical Association
is one of the most influential of the specialties,
and we even have a seated Board of Trustees member.
Anesthesiologists serve as deans, hospital CEOs, medical
directors, HMO executives and politicians. From my
perspective as an Executive Committee member, our
Society is diverse, strong, effective and innovative.
Now comes the “however.” Storm clouds
are gathering, and new challenges will require proper
planning for anticipated changes as well as contingency
plans for unexpected or “worst case” developments.
Medicare is in trouble, and what is worse, Congress
has no concerted long-term plan to steer it away from
the rocks! Conversely a divided, confused Congress
high-tailed it out of Washington for Christmas break,
leaving the 4.4-percent Medicare fee reduction correction
bill for its return in January.
On another front, we see confused gastrointestinal
physicians stating that anesthesiologists are unnecessary
for routine endoscopies but that propofol —
a general anesthetic without a reversal agent —
should be routinely used in their cases! How is that
for the quintessential contradictory statement?
“Omaha Beach would have been lost if each soldier
relied on the person beside him to do the job. So, too,
will our goals fail if we assume that someone else will
do what is incumbent in all of us as ASA members to
do.”
The baby boom population will result in 70 million Americans
reaching age 65 or older by 2030. The implication of
this statement will challenge our Relative Value Guide
payment system, which does not match up so well with
the resource-based relative value system used by everyone
else in medicine. We need to explore novel payment systems
proactively for a time when 70 percent of our billing
may be submitted to Medicare.
On June 6, 1944, an army of 43,250 U.S. soldiers landed
at Omaha Beach on D-Day — about the same number
of members in our Society. The first wave sustained
50-percent casualties. On that day, success against
a formidable and entrenched enemy was not achieved by
an army of 43,000, but rather by 43,000 armies of one.
Each soldier fought shoulder to shoulder with his buddy
until victory was at hand. I am sure there were a few
who panicked or broke down under the pressure and threat
of death — but the vast majority met the challenge,
made the sacrifice and accomplished the mission.
Our challenges in the coming years pale to those sacrifices
made by our fathers. However, the principles of war
parallel the plans of a society. When the alarm is sounded
and a call to arms is requested, we cannot individually
think that “the Society of 40,000” will
tackle the job. Each vested member must realize that
she or he is an army of one and must get actively
involved with the other 40,000 ASA armies-of-one to
directly meet these challenges.
Omaha Beach would have been lost if each soldier relied
on the person beside him to do the job. So, too, will
our goals fail if we assume that someone else will do
what is incumbent in all of us as ASA members to do.
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