Arthur M. Boudreaux, M.D.

hings are getting expensive these days. Gasoline is about $3 per gallon. The interest rates on home mortgages and car loans are rising. And that college tuition I’m paying isn’t getting any cheaper, either. Maybe it’s time to review what I spend and determine whether I am getting a good value for my money. Is my daily grande caramel macchiato frappuccino light at risk? What about my membership in professional societies such as ASA? After all, there is ASA, the state anesthesia society, the county, state and national medical associations and, of course, political action committees. What is the value of my membership in organized medicine? I know that a few of my colleagues periodically conduct a similar evaluation.

Like most professional organizations, ASA sends out membership renewal statements each year. Most members promptly remit payment. In fact ASA membership is currently at a healthy 40,154 and growing. A small percentage of physicians question the value of continued membership. Those who elect not to renew are surveyed. Some reasons given are that the dues are too expensive, component society membership is a requirement, there is a disagreement with policy, or even “I can’t go to the Annual Meeting.” So let’s go through the exercise to determine just “What’s in it for me?”

A value analysis of the $450 ASA dues by a typical doubtful member might go something like this…

I know that in the August ASA NEWSLETTER, Speaker of the House of Delegates Candace E. Keller, M.D., M.P.H., wrote a “Top Ten” list of important ASA activities. The list included publications, practice management resources, the Web site, representation to other organizations, education and research support, continuing medical education, legislative advocacy, patient safety, expert witness review and the ASA Political Action Committee (ASAPAC). It must cost quite a bit to provide those services. In fact if I add up the time spent by the hundreds of volunteers in this organization, the time away from practice and family, the time spent on committee work, providing continuing medical education sessions, writing articles, researching and publishing evidence-based practice parameters and advisories, traveling to Washington to lobby for our patients and the specialty, advocating for us in the house of medicine at the American Medical Association meetings, dealing with the media and the public perception of our specialty, interacting with third-party payers and devoting time to develop relationships at home and across the country to further the goals of anesthesiology… that must be worth quite a lot.

What about my ability to provide input into the practice of anesthesiology? Since ASA is the policy-generating body of our profession, a member should be able to provide an opinion. I guess I could go to the House of Delegates and the Reference Committees at the Annual Meeting. All members are invited, and any member can address the Reference Committee on any pending policy issue. And if I have a specific interest in contributing, I could volunteer for a committee position or work in my component society. The state component society is the backbone of ASA. Without state society input and participation, ASA would accomplish only a fraction of its activity. So the component society appears a worthy investment.

It seems these days that many different people want to provide anesthesia services. There are the scope-of-practice issues with nurse anesthetists, opt-outs, intrusion from physicians of other specialties, development of sedation nurses utilizing anesthetic drugs such as propofol and new Doctor of Nursing Practice programs likely to blur the distinction between physicians and nurses in the minds of patients. ASA is actively involved in protecting patients and advocating for the specialty on these fronts.

Medicare continues to undervalue our services and cut our reimbursement. The baby boom generation will soon enter the Medicare system in great numbers. This will surely affect my ability to provide services and pay for ever-increasing practice overhead. I know that only 10 percent of anesthesiologists participate in the ASAPAC. Perhaps we could do much better. I guess I could respond to those e-mail calls to contact my senator or congressional member on these issues.

I know that ASA is working diligently on the issue of fair reimbursement for teaching anesthesiologists penalized by the Medicare teaching rule. New graduates are the future of our specialty. Strong training programs and the development of new knowledge are the keys to a strong future of the specialty and the health and future of my practice.

Then there are the issues of outcomes measurement and pay for performance. How will these measurements affect my future practice and remuneration? ASA is actively involved in positioning the specialty for participation in this future paradigm.

I am glad that ASA addresses things that may concern my patients such as the recent “Grey’s Anatomy” television show, the not-yet-released movie “Awake” and the issue of physician involvement in execution by lethal injection. At least I have some guidance when patients ask.

Perhaps the best part of ASA is the collegiality of being a part of an organization of members who share common interests and concerns advocating for patients who just might be family and friends.

The bottom line … there’s a lot in it for me and for all anesthesiologists. Hopefully this mental exercise convinces all of us that ASA is a great investment. Perhaps it might entice all to participate more, give more, volunteer, heed the calls for legislative action and work for the future of such a great profession. And, no matter what, I’m not giving up my frappuccino!

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