Hail to the Chief! So, What's It Really Like to Be ASA President?

This month, we will be talking with someone familiar to you all, Dr. Randall Clark, ASA Immediate Past President. Having just finished a busy year as head of our society, Dr. Clark has much insight and many interesting anecdotes about his time in office. If you are like me, you have wondered what professional and personal life changes occur and what type of interactions happen for high-profile ASA leaders, such as those on the Executive Committee, once they take office. And what position could be more high-profile than that of president? I hope you are as eager as I am to hear the thoughts and recollections of Dr. Clark.

Dr. Clark, thank you for joining us. Can you describe your professional life now that your presidential term has completed?

First of all, “LOL” on the title of this piece. I can't remember any ruffles and flourishes during my year as president, but everyone always treated me very nice! After finishing the year in October, I retired from the University of Colorado School of Medicine, although I do hope to continue to help my colleagues at Children's Hospital with a few days of work each month. The patients and professionals I have worked with at Children's are a true pleasure and I already miss that experience.

I hope to use my more than 40 years in medicine and leadership in other ways. I am exploring opportunities to serve on other boards of directors and might even consider returning on a part-time basis to my alma mater, the University of Colorado College of Engineering in Boulder.

What motivated you to run for president?

That's more of an interesting question than you might imagine. In the leadership lectures I give, I emphasize the importance of being what I and others call a “good follower.” Any organization requires good followers to carry out the vision of the group leader. Though I have enjoyed the leadership roles I have had (leading a private practice in the middle portion of my career, subsequently leading the department at Children's Hospital Colorado, and finally serving as an ASA officer), I have also worked hard to improve things and keep the trains running on time from within my groups and departments, even if I was not in a leadership position. I have always been very satisfied with being a “good follower” because you are closer to and get to actually see the fruits of your labors.

As a long-time member of the ASA Board of Directors, I had the opportunity to develop a list of ideas that needed to be tested and possibly put into action by ASA leadership. About eight years ago, I pulled the trigger on that course of action, announcing my intention to run for ASA First Vice President in 2019, and thereby putting myself on the established path to the presidency. I had just completed an assignment for the ASA Board where we removed some governance conflicts in the ASA Bylaws. It led to a fascinating multi-hour parliamentary debate on the floor of the House of Delegates. I figured if I could survive that, throwing my hat in the ring for ASA's highest office wouldn't be so bad.

How many weeks were you away from your practice this past year, and how did your practice support you during this time? Does an individual have to take sabbatical while serving as president?

There was very little ASA travel from the middle of March 2020 until March 2022 due to the pandemic – then things exploded. I was just looking at my airline summary for 2022 and it shows 70 legs as having been flown, which does not even include the half-dozen trips I took flying our family airplane.

Members should know that ASA provides a stipend for the President, President-Elect, and First Vice President. The stipend for President “bought” a little more than half of my time from the University of Colorado School of Medicine. Nonclinical time allotted as a Professor of Anesthesiology and the liberal yet judicious use of vacation time did the rest. The pediatric cardiac anesthesia team I belonged to at Children's was very supportive. I did not feel like I was much help to them during the year, but I tried.

Can you recount/describe a typical workweek or workday while in office?

Each day was different. On Mondays, we had about three to four hours of Zoom calls for the Executive Committee meeting that took place that day, as well as planning for the next Monday Morning Outreach (MMO) and other scheduled meetings during the week. Paul Pomerantz, the ASA CEO, and I spoke by phone most days and had scheduled Zoom calls at least twice a week. Each day had about one to three Zoom calls for ASA business, and each evening had about the same for committees or other work.

Email and preparing or reading reports took a great deal of time. The president is an ex officio member of the more than 100 ASA committees and editorial boards. The committee listservs are in many ways like the circulatory system of ASA. Each officer can give ASA staff a list of the committees he or she wants to monitor. I became the ultimate “lurker” as I monitored the discussions and ideas from about two dozen committees. The creativity and energy of our members is amazing to watch.

To the horror of my wife and daughters, I am sort of an email hoarder. (I have to say there is a reason, as I have thought about using these to chronicle the activities of an officer during the four years of service on the Executive Committee.) I just checked, and I received about 50,000 ASA emails in the three years serving as First Vice President, President-Elect, and President. In that time, I also sent about 10,000 messages.

Which presidential duties did you find most rewarding?

Most state component societies have a formal meeting each year where the ASA President or another officer gives an update on the activities of our society. Attending these meetings and interacting with a huge number of members was really the best part of being president. Nothing compares to hearing from people in these relaxed and informal conversations.

I do have to laugh at the “celebrity” aspect of it. More than once I would be riding in an elevator and someone would ask, “Aren't you the ASA President?” My usual response was, “Yes. God help us.”

I must acknowledge our wonderful ASA staff, especially the senior staff. Anything an ASA President accomplishes is because of them. They certainly made me look better than I have a right to.

Which duties did you find most onerous?

I can't think of anything in my experience that I would consider a burden. The most difficult aspect was receiving the occasional email where I or the ASA failed to meet a member's expectations. Fortunately, that was very rare.

Do you think a one-year term as president is too short, just right, or even too long?

Since I would do it again in a heartbeat, maybe it was too short. In reality, the four-year progression through the offices of the Executive Committee gave me ample opportunities to make a difference. But nothing compares to the experience of being president when a very large number of the important things happening in our specialty pass right before you.

What percentage of ASA members would you say you were able to interact with substantively, and how did you find those interactions?

This is a great question. I would say that I have had some form of direct interaction with several thousand members. My predecessors and I put a great deal of work into the Monday Morning Outreach, which is sent to about 40,000 members. (Sadly, some members decline email from ASA, which makes me wonder if they know what they are missing!) I hope the readers got a sense of my personality in those messages. The MMO gave me great insight into the need to be business-like but to also keep a personal touch.

What is your proudest achievement, and what do you regret that you could not accomplish?

I was able to continue or initiate a very large number of projects in the society. These include expanding mentoring and sponsorship as well as other professional development programs, working with FAER (and others) to increase our exposure to medical students earlier in medical school, re-assessing how the Anesthesia Quality Institute can continue to improve the care we provide, and raising awareness on how we make a difference for our patients. This latter aspect takes a huge amount of time because it includes protecting anesthesia care in the VA system, rolling back pandemic-related emergency suspensions of physician supervision, and countering the endless onslaught of attacks on the practice of medicine taking place in the 50 states.

Probably no single issue occupied more time in the last year than the economics of anesthesia practice. The federal No Surprises Act has the potential to kill our specialty. Our 30-year (and as yet unrealized) goal to fix the severely broken Medicare and Medicaid payment system is the flip side of that coin. I am proud that I have been able to bring some new ideas to that fight, including looking for discrepancies between Medicare/Medicaid conversion factors and what the government pays for anesthesia services when it purchases them directly through government-employed physicians. We are also working on a novel but long-shot legal strategy on Medicare payment reform.

Any advice for ASA members contemplating higher political office in the society?

This is perfect timing as this is the subject of my “Leadership Perspectives” column in, I believe, this month's Monitor (see page 9). I would refer readers to that piece for detailed information on the subject.

What do you do for relaxation/wellness?

I have the best family a person could ask for, so they make wellness easy. My wife and I enjoy watching movies on the weekends and going out to dinner. I have had a lifelong love of aviation, and we have a beautiful airplane. Keeping professionally proficient and up to date on instrument flight procedures takes a fair amount of time. We look forward to more trips in the coming year, especially to visit our daughters, who have completed graduate school and are now working. I love skiing, biking, and tinkering with electronics. I am really looking forward to getting my home office unpacked and organized!

Any parting words for readers?

Serving as ASA President has been the privilege of a lifetime. There is no way for me to adequately thank the members of ASA for the experience other than to continue to try and make a positive difference when I can. Combined with the joys of taking care of pediatric patients, I have had a truly wonderful career, and I hope everyone reading this can experience even 10% of the happiness I have had.

Remember, I welcome feedback and any who wish to volunteer as an Expert and be a co-columnist; please reach out to me atzdeutch@yahoo.com.