SAAC-AAPD in Evolution: Changing With the Times

he Society of Academic Anesthesiology Chairs and the Association of Anesthesiology Program Directors (SAAC-AAPD) thanks ASA and its membership for the support of academic anesthesiology. ASA, its officers and its political action committee expended a great deal of time, energy and manpower in an unflagging effort to defeat the “teaching rule.” This rule decreases Medicare payment 50 percent to anesthesiologists who are supervising residents. It singles out only our specialty’s teaching practices. Thus we started this year already disadvantaged by Medicare reimbursement relative to other specialties; and now, our training programs will be disadvantaged even further. The fight was valiant, and we look forward to the next round.

ASA also supports academic anesthesiology through the newly formed Committee on Academic Anesthesiology. This committee affords our academic community the opportunity to bring together representatives from the Residency Review Committee for Anesthesiology (RRC), the Foundation for Anesthesia Research and Education (FAER), the American Board of Anesthesiology (ABA), SAAC-AAPD and others dedicated to the advancement of anesthesiology education and research.

SAAC-AAPD membership applauds and thanks ASA for its support of the programs and departments that train future generations of anesthesiologists.

Resident Education Changes in Anesthesiology
In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved a new core anesthesiology curriculum with which programs must comply by July 2008. Notable changes in curriculum requirements include an increase from two to four months of critical care medicine and a change in pain medicine from one month of chronic pain clinic exposure to three months of pain medicine — one in chronic pain, one in acute pain and one in regional anesthesiology. Further, the curriculum includes a month-long new requirement in preoperative assessment and additional new months in cardiac anesthesiology, neurosurgical anesthesiology, obstetric anesthesiology and pediatric anesthesiology.

ACGME is currently undertaking projects to examine and improve the learning environment of residents and to archive the progress of a resident’s education and accomplishments in an electronic portfolio. The notion of documentation of competency by physicians in a portfolio format may be adapted by some state licensing boards. In the future, it appears all residents will create a portfolio detailing their accomplishments. The hope of ACGME is to eventually do away with the ponderous Program Information Form (reporting form for accreditation) as we now know it in trade for completed portfolios of all residents in the program. It is possible that continuing medical education will travel along this same documentation pathway.

Evolution of Chairs, Program Directors and SAAC-AAPD
SAAC-AAPD is in the midst of restructuring itself to enable anesthesiology core program directors to become voting members and have a professional home so that they can convene, share experiences, conduct educational and informational sessions and develop a formal voice to SAAC/AAPD.  

Years ago the addition and incorporation of the Association of Anesthesiology Program Directors as a partner to the Society of Academic Anesthesiology Chairs accommodated anesthesiology department leaders whose departments educated anesthesiology residents (they were therefore program directors) but who were leaders at hospital-based rather than university-based departments (and, at the time, did not carry the designation of “academic chair”). The differences between these two types of departmental leaders blurred with time, and both are now referred to as “chairs” and fulfill very similar roles for their institutions. Similarly the distinction between SAAC and AAPD is primarily corporate; and the function of SAAC-AAPD became that of a single organization of chairs.

The work of core anesthesiology program directors changed substantially over the past 10-20 years, with increased workload, responsibilities and time commitment. These changes were, in part, due to increased ACGME educational requirements, increased regulations, increased documentation requirements and Program Information Forms that can easily exceed 1,000 pages.

In the past, most chairs also fulfilled the functions of the program director. With the increased responsibilities of the program director, academic chairs began to delegate the work of program direction to a fellow faculty member with expertise and interest in education. Currently approximately half of the U.S. core anesthesiology programs have program directors who are separate individuals from and report to their department chairs. For any given anesthesiology residency to succeed, the program director and the chair must work hand in hand. It would seem that we should create parity in our professional organizations to reflect that relationship.

At present the anesthesiology core program directors do not have a professional organization; AAPD truly functions with SAAC as the chairs’ organization (program directors who are not chairs currently cannot be members). SAAC-AAPD is in the midst of restructuring itself so that it can enable anesthesiology core program directors to become voting members and have a professional home so that they can convene, share experiences, conduct educational and informational sessions and develop a formal voice to SAAC-AAPD.

M. Christine Stock, M.D., is James E. Eckenhoff Professor and Chair, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. She is ASA Chair of the Section on Annual Meeting.