In the mid-1990s, gloom beset anesthesiology in the U.S. as predictions, widely reported in lay press such as the Wall Street Journal, suggested that the need for anesthesiologists would decrease dramatically in an anticipated managed care environment. Medical graduates were discouraged from pursuing careers in anesthesiology, and residency programs contracted dramatically. In the new millennium, U.S. anesthesiology programs have enjoyed a revival, and many talented medical graduates with strong academic pedigrees have chosen to enter the specialty. Today, new challenges face our specialty, and leaders must be bold, innovative and disruptive in order to ensure that anesthesiology continues to flourish as a vibrant medical specialty.

There are several readily identifiable major concerns that are confronting our field. First, health care costs are rising exponentially. Second, health outcomes are worse in the U.S. than they are in other...

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