SAAC Preparing for Future Challenges

t has been an extraordinarily active year for the Society of Academic Anesthesiology Chairs (SAAC). First and foremost has been our work in conjunction with ASA to achieve parity with other specialties regarding the reimbursement of anesthesiologists supervising residents. Few situations are as foreign to department chairs as lobbying their congressional representatives on the Hill, in their home districts or, in some cases, in their operating rooms. Yet the chairs have by and large adjusted rapidly to these new realities of academic anesthesia today and have very much answered the call.

SAAC is enduringly grateful for ASA’s continued support of the “teaching rule” legislation, and we wish to extend a special thanks to 2006 President Orin F. Guidry, M.D., President-Elect Mark J. Lema, M.D., Ph.D., First Vice-President Jeffrey L. Apfelbaum, M.D., Vice-President for Professional Affairs Alexander A. Hannenberg, M.D., and the ASA Washington Office staff for their tireless efforts in pursuit of this endeavor. It is important to note that while the total amount of money involved from Medicare is but a small portion of the Centers for Medicare & Medicaid Services pie, the financial impact of these Medicare “teaching rules” are multiplied in academic departments as they are increasingly also adopted by private payers. Thus this simple fix can have far-reaching effects and may well ultimately make the difference in our academic departments meeting their missions of training the next generation of anesthesiologists and developing the paradigms to provide the anesthetic and perioperative care of the future.

While programs decline, great applicants remain interested. Anesthesiology once again experienced a banner year for resident recruitment. The overall number of applicants matching into anesthesiology increased, as did the number matching into other fields. Thus the overall percentage of applicants matching into anesthesiology remained fairly stable at 5.5-5.7 percent of all applicants for the past several years. Of course there have been “troughs and valleys” in resident recruitment, but our current national class size is very close to that before the dip of almost a decade ago.

Yet our academic departments continue to struggle. The total number of core training programs for anesthesiologists has been reduced by 14 over the past decade, and six or seven programs are currently on probation. While educational quality was no doubt the guiding factor in these decisions, the financial underpinnings of the departments may well have influenced their ability to provide quality training (which takes us back to the Teaching Rule). It may be worth noting that, in contrast, the number of anesthesiology training programs for nonanesthesiologists has surged, resulting in the potential for a change in the landscape of anesthesia providers in the not-so-distant future. Similarly, turnover in department chairs remains high compared to other specialties, at about 20 percent per year. In several institutions, anesthesiology chairs have now been replaced with interim chairs from other specialties who are not anesthesiologists. This worrisome trend has now included a fine program from a top quartile medical school.

Educational initiatives. SAAC has enjoyed the opportunity to work closely with the Residency Review Committee (RRC) for Anesthesiology and was pleased to support the most recently approved revisions in the program requirements for residency training. In addition a committee was appointed to work with the RRC to review language from future proposals for changes in the training requirements, and space was provided on the SAAC/Association of Anesthesiology Program Directors (AAPD) Web site for educational articles of interest.

Increasingly subspecialty fellowship training programs are requesting and being granted accreditation by the Accreditation Council for Graduate Medical Education (ACGME). In addition to intensive care, pain medicine and pediatric anesthesiology programs, cardiac anesthesiology programs are now accredited, and a proposal requesting accreditation of training in obstetric anesthesiology is anticipated in the near future. Other subspecialties are certainly preparing to follow this trend. Thus providing mechanisms of sharing information with and between subspecialty program directors have become increasingly important.

Last year SAAC/AAPD organized the first “Primer for Program Directors,” an open session held at the ASA Annual Meeting in conjunction with representatives from the ACGME, the RRC and the American Board of Anesthesiology. This venue was chosen by the leaders of the program directors from the various subspecialties, with the goal of disseminating information without the need to incur any additional travel expenses. Attendance at the primer exceeded that of the SAAC/AAPD Annual Meeting, and evaluations overwhelmingly affirmed the value of the session to the participants. The session was repeated again this year in Chicago.

Societal structure. Over a decade ago (and before my time in SAAC), a new category of membership was created for chairs who did not have a direct reporting structure within medical schools and who thus did not qualify for membership in SAAC. These chairs were labeled “Program Directors,” and the Society of Academic Anesthesiology Chairs became the Society of Academic Anesthesiology Chairs/Association of Anesthesiology Program Directors, or SAAC/AAPD. It was (and is) the forum for chairs to meet. Today some chairs are members only of SAAC, some only of AAPD, and many of both SAAC and AAPD.

Yet almost half of the program directors in the country are no longer department chairs, and many more are directors of subspecialty fellowship programs. Last year a task force was formed to discuss how residency and fellowship program directors might be included within the existing organizational structure of SAAC/AAPD. The recommendations of the task force shall be presented at the SAAC/AAPD Annual Meeting (which takes place after this publication deadline).

In summary, anesthesiology is experiencing the brightest period in many years with respect to recruiting young physicians into our field. Yet our departments are struggling, and the standing of our specialty may be under challenge within our teaching institutions. ASA’s academic component is most grateful of the Society’s efforts as we address these issues together.

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