Over the last few years I have attended many state component and subspecialty society meetings, sitting through presentations while waiting for my turn to speak. This has introduced me to new science, ideas and clinical strategies that I have brought back to my practice. However, I have been struck by talks regarding the challenges facing anesthesiology and extrapolating them to a dystopian future. The basis of these concerns are what you would expect: government regulation becoming so complex and restrictive that it will be impossible to fulfill their requirements (e.g., MACRA); private insurance companies rushing to the bottom and our fees will crater; the advent of large group practices destroying professionalism in anesthesiology; bundled payments edging out adequate payment to anesthesiologists; hospital systems replacing physician anesthesiologists with less-qualified individuals, and so on.

While there are challenges on the horizon,...

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