“Don't worry. It'll all work out.”

Many years ago, when I was just beginning my career in anesthesiology, I joined a private practice group. Although I was very busy with my clinical practice and a young family, I felt that there was something missing. I felt that I could contribute more than just clinical care. So, I joined the Texas Society of Anesthesiologists and ASA. It was a great decision. It was tremendously fun and inspiring to meet accomplished and like-minded physicians. Shortly thereafter, one of the senior physician partners in my practice asked me why I was spending so much time and effort on these legislative, political, and advocacy initiatives. I told him I thought that anesthesiologists needed to be involved in leading the direction of the specialty. He was quite dismissive and non-supportive, telling me that our collective efforts were a waste of time. He said, “Don't worry. It'll all work out.”

I have never believed that, and I firmly reject that premise to this day. Physicians, and anesthesiologists in particular, have an opportunity to educate the uneducated, to influence the intransigent, and to lead our science and our art to a better place than it has been. But to do this, and to do it well, will require a great unified push. First, anesthesiologists must understand the many and significant threats that our specialty currently faces. Second, while we have made incredible strides toward advancing the practice and securing the future, to be even more successful will require a sustained and focused commitment from a larger number of individuals than have been involved thus far.

Allow me to outline just a few of the current threats that anesthesiology faces. Note that the space restrictions of this publication limit what I can discuss to only a few of the hot issues.

  • Payment: As someone once said, “no money... no mission.” Anesthesiologists routinely perform clinical care, consultations, research, education, and more. We deserve to be paid appropriately for this. Yet, each year, government payers attempt to ratchet down payment to anesthesiologists. Trending demographics are also against us, because as the baby boomer cohort ages, more and more patients are moving into the government payment sphere. And while government payments continue to stagnate or worsen, health plans have grown larger and more aggressive in their negotiating tactics. Some plans are restricting anesthesiologists' access to their narrow networks, while simultaneously blaming physicians for out-of-network billing.

  • Medical Title Misappropriation: Although you worked very hard for many years to attain an MD or DO degree and your subsequent specialty training qualified you to become an anesthesiologist, there are others who are less trained and less qualified who seek to present themselves as anesthesiologists. Although you and I know the difference between physicians and nonphysicians, how clear will that distinction be for patients when the nonphysician person in front of them introduces themselves as a “doctor” and an “anesthesiologist”?

  • Scope of Practice Expansion: The highest-quality care and clinical outcomes occur when a physician anesthesiologist is centrally involved via a physician-administered or anesthesia care team model. ASA supports physician-led, patient-centered anesthesia care for every patient as the gold standard of medical practice.

  • Surprise Medical Bills: Federal legislation has been passed. In 2021, the regulations are being discussed and created. The nuances of independent dispute resolution, the appeals process, etc., are critically important to a fair process and appropriate payment.

  • The cost of becoming a Board-certified anesthesiologist has risen dramatically. In their report to the 2021 ASA House of Delegates, the ASA Resident Component estimates the direct cost of becoming an anesthesiologist (including university, medical school, residency, and board certification) to be in excess of $500,000, and the financial opportunity costs are also significant. Given these financials, will we be able to train sufficient physician anesthesiologists for the future?

Can we reasonably expect that critical issues like these will “all work out?” The short answer is... yes, but with a big qualifier. Without active physician involvement and advocacy, the outcome may not be optimal for our medical specialty and our patients. If we wish to achieve outcomes that are better than what we have achieved in the past, we must have a higher degree of participation and commitment. Even though ASA has over 50,000 members, too many of our members do not engage – they do not support our grassroots or political activities. This is disappointing, but another way to look at it is that we have tremendous potential for improvement. The legislative, regulatory, and financial determinants of our society can be responsive to focused advocacy. However, effective advocacy requires sheer numbers of involved members and strategic use of political assets. We need more of both.

What are some things that you can do to help? Make sure that everyone in your department or practice is a member of ASA. Support ASA's and your state component's political initiatives and the Grassroots Network to stay up to date on the latest legislative and regulatory issues. Go to an ASA annual meeting and sit in on a governance session, i.e., the ASA House of Delegates. It's open to all ASA members and there is no cost.

The American Society of Anesthesiologists is a remarkable organization. The expertise of the staff and the efficiency of its operations amaze me every day. This is an organization that is working unbelievably hard for its members, but we need more active members and more advocacy assets to deploy. “Don't worry. It'll all work out” is not a strategy for success. Let's commit to enlarging our physician anesthesiologist community and pooling our resources and efforts to influence our destiny.

Patrick Giam, MD, FASA, Speaker, House of Delegates, and Physician Partner, U.S. Anesthesia Partners, Houston, Texas.

Patrick Giam, MD, FASA, Speaker, House of Delegates, and Physician Partner, U.S. Anesthesia Partners, Houston, Texas.