Medical Student Rural Scholarship
Attention medical students interested in rural anesthesia rotations! This year the Committee on Rural Access to Anesthesia Care focused on developing a rural medical student scholarship program. The 2005 ASA House of Delegates (HOD) passed a resolution to study rural anesthesia classes for third- and fourth-year medical students. The 2006 HOD passed a resolution to support a three-year pilot scholarship program. The application for financial assistance for this rural medical student anesthesiology rotation is on the ASA Medical Student Web page www.ASAhq.org/msd. Look at the top right corner under “What’s New?”

This assistance is awarded under the Foundation for Anesthesia Education and Research (FAER) to allow for tax-deductible donations to supplement ASA’s funding of this scholarship. The ASA HOD agreed to fund the scholarship program with $10,000 per year for three years. The scholarships awarded will be up to $750 per student to help pay for expenses for travel and lodging for a rural anesthesiology clerkship. We encourage medical students interested in anesthesiology to apply. We also encourage donations to FAER earmarked for this scholarship to increase the number of students assisted. You can donate online as I have at www.faer.org. Click on “Make a Gift” on the left side of the Web site. While filling in the online donation information, please type into the “comments” section, “Rural Medical Student Scholarship.” As a Montana anesthesiologist, Paula Roos, M.D., told me, “This is a great way to pay it forward in anesthesiology.” We also plan to work closely with the ASA Resident Component to support efforts to encourage rural rotations.

Rural Medicare Payments
The Rural Access to Anesthesia Care listserve encouraged its participants to send letters to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed anesthesia conversion factor increase. We have worked with Congress to increase Medicare reimbursement directly to rural physicians and hospitals. The 2003 House of Delegates passed a resolution to support legislation for parity in Medicare payments. It was a major accomplishment when the 2003 Congress supported the concept of “equal pay for equal work.” The geographical practice cost index was raised to set a floor at one. This increased 2004 Medicare conversion factor payments by about 8 percent to 9 percent for rural providers because of legislation in the Medicare Modernization Bill. The Committee on Rural Access to Anesthesia Care supported legislation this year in the House, H.R. 3162, Section 621, “Two-Year Extension of Floor on Medicare Work Geographic Adjustment,” which would extend the current floor on rural Medicare payments to the end of 2008. The House and Senate have scheduled a conference committee in September to resolve the differences in the State Children’s Health Insurance Program, or SCHIP. The committee will continue to support this rural floor in whatever legislative vehicle is appropriate. Of course we also support ASA’s efforts to fix the flawed sustainable growth rate formula and teaching rule issues in Medicare payments.

Small Component Assistance
North Dakota Society of Anesthesiologists Director John C. Chatelain, M.D., proposed a resolution passed by the Board of Directors in August 2007 to assist small component societies with the transition from one director to the next. It was resolved “that the President of the ASA ask a committee of his choice to consider offering funding for the expenses of bringing alternate directors from components with limited numbers of active members to attend one board meeting during the final year in which their current board member is planning to retire.” The committee supports this referral. ASA already provides some administrative assistance to small, often rural, components.

Obstetrical Coverage Issues
Concerns continue about providing better labor analgesia coverage and vaginal birth after cesarean section (VBAC) availability while still servicing the operating room with limited staff. Some hospitals are requesting labor epidurals instead of intrathecal narcotics even in areas with fewer than 500-700 deliveries per year. This labor epidural coverage requires more anesthesiologists/nurse anesthetists to be available to provide coverage for the same number of patients. Some hospitals are asking for in-hospital coverage for VBACs, even when there are fewer than 20 per year. Many rural hospitals and anesthesiologists have agreed to payment arrangements to help compensate anesthesia and improve recruitment and retention of anesthesiologists and nurse anesthetists. Some states have significantly increased their Medicaid payments toward commercial parity to encourage access to medical care for patients.

Join Rural Anesthesiology Discussions
The committee encourages any ASA member interested in joining our listserve to subscribe to rural@listserv
.ASAhq.org. When sending a message, please write “Subscribe” in the subject line of the e-mail. We encourage open discussion — the best ideas have come from these open Internet comments. The committee has presented informational sessions at the ASA Annual Meeting in 2006 and 2007 regarding the challenges and joys of rural practice. The objective is to increase awareness of professional opportunities and the ease of implementing “best practices” in a rural setting. Our goal is to improve access to high-quality rural anesthesia care.

Members of the committee are: Lee A. Balaklaw, M.D. (adjunct), John C. Chatelain, M.D. (adjunct), Paul G. Loubser, M.D., Kenneth Martay, M.D. (adjunct), Paul D. Martin, M.D., Ray J. Nichols, Jr., M.D., H. Douglas Roberts, M.D., William A. Roberts, M.D., Ph.D.

Mike P. Schweitzer, M.D., is Medical Director of Perioperative Services, St. Vincent Healthcare, Billings, Montana.