Residents’ Review: Start With ‘Why’ and See Where We Go

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November 1, 2013 Volume 77, Number 11
Residents’ Review: Start With ‘Why’ and See Where We Go Mark C. Bicket, M.D., President
ASA Resident Component

It’s not uncommon to encounter feelings of uncertainty about the future. As a resident, one usually does not have to look far to encounter a sense of the unknown. For example, there is the immediate and practical sense of, “How is my patient going to do during and after the operation?” and the more farsighted ideas of “Will I pass my boards?” and “What will life be like after residency?” Perhaps more important to all of our future careers, changes resulting from health care reform introduce questions of, “What will my role as an anesthesiologist look like down the road?” But as often as these questions evoke feelings of uncertainty (and others such as worry, concern and frustration), we can also ask, “Why should we share excitement about the future of our field?”


A little more than four years ago, I made a discovery that changed how I approached the question. Yes, uncertainty may be present regarding anesthesiology, but it’s present in most of other medical fields and most other non-medical careers as well. It turns out that the core of our specialty will always be in demand, regardless of the uncertainty or cycles of reform that may come in the future.


So what is the core of anesthesiology? We know that we as anesthesiologists-in-training help make modern medicine possible. More patients undergo more surgeries every year, and the need for life-saving care when seconds count is growing by the day. As physicians trained in caring for the most complex patients, we touch patients at virtually every location within the modern hospital and surgical setting. We interact with them at the most critical junctures in their health care journey. The elderly man having a CABG, the cancer patient seeking relief of metastatic pain, the child needing an arm fracture repaired, the laboring parturient desiring an epidural, the trauma victim needing a definitive airway, the coding patient in the ICU, and others – they are all united in their need for care provided by an anesthesiologist. We help lead the teams that safely care for patients both one-on-one and on broader organization levels.


It can be difficult to communicate these dimensions of our specialty by telling others – our colleagues, friends and family – how we spend our day. Perhaps to casual observers, who may only observe the mechanics of part of our workday, our tasks can seem less than inspiring. Gosh, couldn’t anyone look at a monitor and give some medication?


But the truth is that the mechanics of what we do are only a tiny fraction of the story. The real meaning lies in why we do it. We are privileged as anesthesiologists to provide care in the most critical situations to patients of any age and condition because we are leaders in patient safety and share a vision of reducing patient harm. We serve as physician leaders across the hospital and surgical setting because we strive to improve the quality of health care delivery for every patient we encounter. Our responsibility and passion for patient care constitutes the basis for our advancement of our specialty and of patient care in general. That march forward happens by educating patients, other physicians and the public about how and why we help make modern medicine possible.


So given that framework, what opportunities are available to you to help invest more in the reason why you are an anesthesiologist? At a global level, people are exposed to unsafe surgery. What hits closer to home is that they are exposed to unsafe anesthesia. Too many patients undergo surgery without access to what most of us consider a bare necessity, a pulse oximeter, for example – perhaps one of the most common and standard monitors whose “beep, beep, beep” we take for granted in the United States. Anesthesia resident Brian O’Gara, M.D. and other resident leaders continue to make a difference by sponsoring Lifebox fundraisers at the local level. You can join this effort to improve the safety and quality of surgical care in low-resource countries by raising funds for the Lifebox organization. Look for more details on the Lifebox National Challenge for Residents from fellow resident Falan Mouton, M.D. and myself in the future.


At a national level, our health care system faces reform. Whether these reform efforts will improve the quality of health care delivery and the specialty of anesthesiology remains to be seen. You can make an impact by stepping up and making your voice heard about your concerns to your congressperson and senators. The ASA Lansdale Public Policy Fellowship provides a one-year fellowship and pairing with a member of Congress or Executive Branch office. Recently, Michael Oleyar, D.O. made a difference in health care policy as a resident anesthesiologist in this role. Leadership opportunities for residents also include the four-week ABA-approved ASA Policy Research Rotation in Political Affairs in Washington, D.C., and numerous ASA committees to fit any specific interest you may have. Committee applications are typically due in January.


Finally, anesthesiology often lacks a clear presence from residents. Resident participation in political and grassroots activity is starting to change that. To find out more about ASA’s resident political and grassroots opportunities, contact Michelle Mathy of ASA’s Advocacy Division at Your state anesthesia society will likely also welcome you with open arms and be interested to hear more about how they can help invest in the reason why you are an anesthesiologist.


That can be a lot to take in. But for anesthesiologists-in-training like us, our careers are still just beginning. This makes it all the more important to pause for a moment and ask a fundamental question. By starting with “why?” you might just be surprised to see where we can go in the future.

Mark C. Bicket, M.D. is Chief Resident, Johns Hopkins Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland.