adam Speaker, President Guidry, fellow officers, directors, delegates, ASA staff and guests.

The next decade will bring sweeping changes to American health care that will challenge the traditions of medical care itself. Health care in America is receiving “C-“ grades when compared with other nations. Benchmarks for international medical practice standards depict the U.S. as having a dichotomous health care policy. On one hand, the tidal wave of technological advancement is drowning providers, payers and patients in a sea of new treatments that have limited outcome data to fully support their usages. On the other hand, intense market competition among payers has turned access to health care providers and advertised therapies into a progressively entangled web.

As an example of this medical quagmire, the U.S. now spends 15 percent of its gross domestic product on health care; yet with respect to the delivery of measured therapies, American medical providers prescribed required care only 55 percent of the time! For this reason, Congress is attempting to hold doctors accountable for their decisions by providing incentives through the “pay-for-performance” program. This program represents a major change from the Centers for Medicare & Medicaid Services (CMS) simply paying for care to CMS now demanding that medical care be linked to outcomes.

“ … if each physician committed just 3 percent of clinical time to advance our principles and issues in state capitols and in Washington, about 3.5 days could be freed up each year to effectively talk with lawmakers about the threats to safely providing anesthetic care.”

In his book Only the Paranoid Survive, Andy Grove, former CEO of Intel Corp., put forth a business idea that is most applicable to anesthesiology’s future metamorphosis. He said that all businesses evolve until they reach their “Strategic Inflection Point.” This point is the time when a company’s fundamental practice principles are about to undergo a change. Grove then states, “That change can mean an opportunity to rise to new heights. But it may just as likely signal the beginning of the end.” I believe that in this situation, “fate favors the prepared mind.”

Many anesthesiologists assembled here remember the “formative” years of anesthesiology. It was a time when anesthesiologists were establishing our young specialty as the practice of medicine and making anesthesia safer. Today, anesthesiology is not only a mature specialty but is currently one of the more popular specialties in which to train for graduating medical students. However, working in an established specialty with a good standard of living has also made anesthesiology a “poachable” specialty. We now have physicians in other disciplines seeking either to provide or supervise anesthetic care in the ERs, ICUs and office-based centers for the purposes of augmenting their income, speeding up their procedures or reducing anesthesia costs. These doctors perceive anesthesia to be so safe that anyone can quickly learn it, yet fail to appreciate the continued effort needed to maintain safety in a high-risk/low-incidence discipline.

As we experience these undefined, abrupt changes in medical care, our specialty must adapt to sudden alterations in health care delivery. We need to anticipate the “medicalization” of certain surgical specialties and change our services to provide anesthesia for both short, intense procedures and long, minimally-invasive surgeries — not in the way we administer the drugs but in the way we oversee an increasing number of anesthetic sites throughout the hospital and even throughout the community. Telemedicine will likely become the conduit for supervising anesthetic care to multiple and remote sites, and we must be prepared for this disruptive yet innovative technology.

With these new challenges facing our specialty, it is a great privilege to serve as the next ASA president. The presidency is a blur in time when you live it through the eyes of an executive officer. My goals for changing and evolving our specialty will be tempered by the reality that each project is a multiyear task and that “crises” will require my immediate and undivided attention. Nonetheless, I am committed to addressing three critically important issues that will affect the success of our specialty.

The first issue is academic anesthesiology’s struggle to survive in an environment that scoffs at financing the training of the next generation of doctors. I am committed to reversing this trend by any means, for without a steady supply of bright, young anesthesiologists, this ballroom address may no longer be necessary.

The second issue is investigating alternative payment methodologies well in advance of anticipated problems with a failing Medicare system, an aging population and an impending paradigm shift in medical care. Our Committee on Economics has been asked to research different payment structures for presentation at a future meeting when completed.

The third issue is developing our specialty’s evolutionary changes in order that anesthesiology moves in harmony with the inevitable new developments in health care delivery. I have reappointed the Task Force on Future Paradigms of Anesthesia Practice to re-evaluate our status and to offer recommendations for change.

Finally, I would ask that everyone in this assembly help me to accomplish these goals by participating in what I have termed the “3-percent solution.” This concept will allow every anesthesiologist to consider and implement an action plan to help our specialty thrive in the areas of advocacy, recruitment and education.

First, if each physician committed just 3 percent of clinical time to advance our principles and issues in state capitols and in Washington, about 3.5 days could be freed up each year to effectively talk with lawmakers about the threats to safely providing anesthetic care.

Second, if every person contributed just 3/10 of a percent (0.3 percent) from their net income to PAC donations, over $12,500,000 would be raised for ASAPAC, state PACs and AMPAC so that our messages have the appropriate impact on the lawmakers.

Third, the future success of our specialty depends on a healthy influx of enthusiastic trainees. This process begins with getting medical students excited about anesthesiology and continues with assisting in the education and training of our current residents and fellows. Donating 3 percent of your time, which is two hours each week or 3.5 days each year, to electrify students about what you do and to energize residents to excel in their skills, will ensure that our ranks stay enthusiastic, informed and plentiful.

I realize that many in the audience are doing some or all of these actions on a regular basis. Your efforts are sincerely appreciated. However, I would also ask that each person encourage one additional colleague to help in this program, and in turn that person persuades another to help until a majority of members engage in making anesthesiology thrive.

It will be my privilege to work closely with two gifted officers, Dr. Jeff Apfelbaum and Dr. Roger Moore as well as the multitalented Administrative Council, to guide our Society through the uncertainties of the coming year. I will also have two excellent role models by whose examples I will carry on the business of the Society and advance the plans and goals of ASA. Drs. Orin Guidry and Gene Sinclair have been one of the best back-to-back leadership teams ASA has ever experienced. I will draw on their decades’ worth of experience at the administrative level to assure that complex decisions are properly vetted and that innovations to our practices have been thoroughly developed and properly timed.

I enthusiastically accept the challenges of this office and pledge to leave it next year with the Society a little better off than it is today. However, I am reminded of an aphorism that I heard a past president, Dr. Rick Siker, use some years ago: “Just when you make plans, life happens!” So with that in mind, I’ll be ready for whatever comes my way during the next 12 months.

Thank you for your trust and confidence in my leadership abilities. God bless our country and the ASA.

ASA President Mark J. Lema, M.D., Ph.D., left, and Immediate Past President Orin F. Guidry, M.D.

Mark J. Lema, M.D., Ph.D., is Chair, Department of Anesthesiology, Pain Medicine and Critical Care, Roswell Park Cancer Institute, Buffalo, New York, and Professor and Chair of Anesthesiology, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences.