he last election has come and gone, and the new Congress is back to mischief — er, work. The next national election is almost two years off, and primaries still a year away. The temptation might be to put politics on the back burner and not think about it for a while. The war in Iraq and who’s running for president are the main political concerns. NOT SO! Congress is in session, and major issues affecting the future of our specialty remain unresolved. On behalf of our specialty, ASA’s officers and the Washington Office staff continue to promote those issues that are at the heart of our future.

Ronald Szabat, J.D., LL.M., Chief Operations Officer — External Affairs and General Counsel in the Washington Office, summarized the issues still before us in the December 2006 issue of the NEWSLETTER: the sustainable growth rate formula, low payments from Medicare for our services, the anesthesia teaching rule, rural access to the services of anesthesiologists, the possibility of more state Medicare opt-outs, pay-for performance, and reduced funding by the National Institutes of Health for anesthesia research. In addition there are numerous state issues such as office-based surgery, pain medicine and scope of practice. Politics plays an important role in the future of our specialty, and so the work is unending.

Health and medical care in the United States is evolving rapidly, and major changes will need to be made if the whole system is not to collapse under its own costs. Most changes will bear a legislative imprint. Market forces also will contribute to changes that will affect how and where anesthesiologists practice. The trend toward more office-based procedures with sedation provided by nurse sedation specialists is but one example.

If our specialty is to survive in the not-too-distant future, we will obviously need to adjust and evolve as new drugs, technologies, economics and politics change the overall health/medical care paradigm.

I’m sure that many think that our efforts don’t bear much fruit, but ASA remains steadfast in keeping our issues before legislators. It is frustrating to see the same issues come back year after year, but they are still issues we have not lost. One thing is certain, no one ever won by not playing the game. Those who don’t show up are assured a loss. More anesthesiologists need to be even more active in the political arenas. Politics impacts both the business and the clinical delivery of medical care. Anyone interested in any of the issues cited in the second paragraph should be interested in politics enough to get more involved.

At the second session of the ASA House of Delegates in October 2006, incoming ASA President Mark J. Lema, M.D., Ph.D., distributed to all in attendance a card encouraging each ASA member to “BE A 3% PLAYER.” The card suggested three goals and that we try to complete two of those three every year. With Dr. Lema’s permission, the three goals are:

• Donate 3 percent of your clinical time — two hours each week or up to nine 10-hour days each year — to engage in political advocacy (visiting lawmakers in their district, attending state lobby day, participating in the ASA Legislative Conference, writing to legislators, etc.).

• Donate 0.3 percent of your net income (about $500) for political action to political action committees and federal and state candidates. Political dollars allow medicine and your specialty to support candidates who support your issues.

• Donate two hours each week engaged in teaching residents, fellows or medical students about the principles and practice of anesthesiology. This effort promotes recruitment into the specialty and enhances medical knowledge for safer patient care.

If You Don’t Help Yourself and Your Specialty, You Allow the Opposition’s Issues to Shape Your Career
Dr. Lema encourages all of us to be PLAYERS. On athletic teams, some players are first-string, some only get to practice. The cheerleaders and fans in the stands also contribute to that home field advantage. Even the least vocal fan contributes by showing up. The present and future of our specialty is not a game, but we all need to be players. There is a position on this team for everybody, and the more people we have on the field of play the more likely we will succeed.

Only about 11 percent of ASA members participate in any type of political activity. When ASA sends out the call to members to write or call their Congresspersons on an issue, the response is 5 percent or less. There is a lot of room for improvement in participation rates. This specialty, including its future, belongs to all of us. BE A PLAYER — A 3% PLAYER.

Charles D. Gregorius, M.D., is a staff anesthesiologist, Bryan LGH Medical Center, Lincoln, Nebraska.