Opening Session Address at ANESTHESIOLOGY 2020

2020 ASA President Mary Dale Peterson, MD, MHA, FACHE, FASA
October 3, 2020

Good morning and welcome back to the ANESTHESIOLOGY® 2020 annual meeting. I hope you were able to attend yesterday’s Welcome Session with Dr. Helge Braun, Germany’s Head of the Chancellery and Federal Minister for Special Affairs as well as Vice Admiral Jerome M. Adams, the U.S. Surgeon General. Their presentations were captivating.

While we can’t be together this year, there are more than 13,000 members participating in this annual meeting – more than 7,000 active members and more than 4,500 resident and medical school attendees! This meeting is jam-packed with tremendous educational opportunities, including 12 clinical tracks and hundreds of presentations including more than 500 scientific abstracts, 100 problem-based learning discussions and more than 800 medically challenging cases. I hope you have taken advantage of the time available to you earlier in the virtual environment to complete your profile and build your custom agenda.

I would like to thank Dr. Meg Rosenblatt, Chair of the Annual Meeting Oversight Committee, and all the committee members, as well as ASA staff for their hard work to ensure a successful meeting.

And now, please join me in thanking ASA Industry Supporters for their year-round support of ASA and the anesthesiology specialty:

  • CAE
  • Edwards Lifesciences
  • ePreop 
  • Fresenius Kabi 
  • Heron Therapeutics 
  • Masimo 
  • Medtronic  and
  • Merck

I’d also like to thank our Annual Meeting Supporter, Acacia Pharma.

Some other important features and activities to note for your agenda: Carve out time to participate in non-CME educational activities designed to expand your knowledge and practice solutions. These include Sunrise Sessions to jump start your day; Satellite Symposia for mid-day breaks; and Table Talks, small roundtable discussions at the close of each day.

Finally, please be sure to visit “ASA Connect” to update you networking profile and indicate your areas of interest to foster deeper, more meaningful connections and networking. ASA Connect helps you meet attendees and industry participants based on your unique clinical and topical interests.

What a year it has been! Never in my wildest imagination did I ever think this year would go in the direction it went. Wow. But in reviewing the year as I wrote this, I realized this was definitely the Moment We Were Made for.

This year you showed me and the rest of the world why we are here. We are here to save lives. It is as simple as that and yet it is complex. This year our advocacy efforts went in directions I never could have imagined. In March I began to get emails from members like Kevin Becker describing their struggles with not having PPE or being allowed to wear it or even wear their own self purchased PPE. I think another member, Sean Runnels, said it well: “Human capacity trumps all – ventilators, drugs, and hospital beds are only effective if health care workers are available. People are the medical system.” Indeed, they are.

That is why ASA was the first medical organization to issue multiple statements on PPE. We worked alongside the APSF to provide guidance on reuse and sterilization of respirators. By the way, I want to give a shout out to the APSF and congratulate them on their 35th anniversary. 

We urged the President to invoke the Defense Production Act to make more PPE. We worked hard to protect our greatest and hardest-to-replace asset in this fight to save patients – and that is you! We advocated to ensure we had enough drugs and equipment to care for our patients – working with the FDA, the White House Task Force, and the Assistant Secretary for Preparedness and Response.

The next front we worked on was education. Never before in the history of ASA have we developed the quality and amount of education in such a short time frame so that you had the ability to reconfigure anesthesia gas machines into ICU ventilators, or refresh your critical care knowledge to work in the ICU again. ASA worked with our subspecialties and sister organizations to build the resources to support you in the care of the pediatric, obstetric, neuro, or ICU patient. We delivered this information in weekly town halls attended by more than 5,000 members in each one.

While ASA was working on creating a safe workplace, providing education, and advocating for tools needed to take care of our patients, the VA, some states and Health and Human Services enacted emergency orders eliminating supervision of mid-level professionals. We know this wasn’t needed to ensure an adequate workforce for anesthesiology – half were idled with prohibitions on elective surgeries and procedures. We continue to work hard to ensure that these emergency orders don’t become the new norm when they expire. Crisis standards are not optimal care.

Before the pandemic, economics was the number-one issue I wanted to address. It remains our number-one issue. We continue to work for COVID relief funds. While some of you were able to take advantage of the Paycheck Protection Program, we know there hasn’t been enough funding to offset the losses we have experienced. We will continue to advocate for our CASPR bill that recognizes the work we have done during the pandemic. But that is not enough. The flaws in the Medicare payment methodology from 40 years ago become compounded every year. 

Let me explain what we have done so far, despite the demands that the pandemic placed on all of us. We have released our 33% paper on the history of this flawed methodology as well as where we have had successes in the past, so we can find a future path. What is that future path? Is it to give up time and join the RBRVS methodology like our physician counterparts? Or should we go to time only like the new outpatient evaluation and management payment system? Any potential solution has inherent risks, but I suggest to you that the status quo of begging for less cuts like we have been doing for decades is not working. In addition to our 33% analysis, we are anxiously awaiting a GAO report we requested to compare Medicare payments with commercial payments for all specialties. I knew we couldn’t solve this problem in a year, but we have made progress.

Another area we need to work on – health equity. Our federal spending on health creates a two-tiered health care system. For those of us working in safety net hospitals, we know this. Hospitals with a higher government payer mix cut costs by cutting physician staffing. Medicare and Medicaid payments do not support optimal staffing to provide quality care. We know that commercial payments, which used to make up the shortfall, are shrinking while insurance company profits soar. It shouldn’t matter what ZIP code you live in. If you are having a baby or in an accident, you should have access to physician-led anesthesia care wherever you are.

This pandemic has brought to light the changes that we need, especially for women trying to juggle child care and their careers. This reached a breaking point with schools and day care centers closed. While some institutions put a pause on the clock for career advancement requirements, not many are providing the real, concrete help that working parents need so they don’t have to take furloughs or put their careers on hold. I hope we can find solutions to keep women in the workforce and able to advance their careers.

Despite our many challenges, the future of our specialty is bright. We had our best Match year ever and many more who wanted to match into anesthesiology but didn’t. Many hospital administrators now know our versatility – our ability to step into the ICUs, to coordinate repurposing anesthesia machines, or transforming ORs into ICUs. We need to continue to develop and show our leadership skills in our hospitals.

David Zweig highlighted anesthesiologists in his book the Invisibles: Celebrating the Unsung Heroes of the Workplace. This year we have become the visible with twice the media exposure than prior years. We even made the cover of Time magazine!

We have been tested. I think we passed the test. As one reporter told me, I now realize the person I really needed to thank after my surgery was my anesthesiologist. This is the moment we were made for! Thank you.