I've been writing these articles for the past eight years, and I've been reading them for much longer than that. As I sat down to write this year's piece, it struck me that every article has one thing in common – they're written for members. I decided to try something new this year and write a letter to NON-members. I know what you're thinking – how can he write a letter to non-members, in a member-exclusive publication? It's a very good question and one that, frankly, I don't have a good answer for. But there are things that need to be said to non-members, and I have faith and confidence that in today's free-flowing media, this message may find its way to some of my target audience.

Dear ASA Non-Member:

I hope that you are doing well and that you are enjoying a fulfilling and successful professional career. I bet that you worked hard to get where you are today. You should feel very proud to be part of a noble profession that has an incredibly positive effect on society.

In many ways, our profession is experiencing the best of times. Compensation is strong, driven in part by a seemingly insatiable demand for anesthesia services both inside and outside of the OR. Every single residency spot is being competitively sought by a remarkable group of highly qualified medical students. In fact, last year, every residency spot filled, and almost 900 qualified medical students had to be turned away.

But we are facing challenges that threaten the well-being of our field and our physicians. Nurse anesthetists seek to expand their authority beyond the level of their education and training – with our nation's Veterans as their immediate target. Governmental payers continue their incessant downward ratcheting of reimbursement, and now they've been joined by health insurance companies that are aggressively and inappropriately manipulating the No Surprises Act. We are also experiencing the highest level of workforce shortfall of this generation, which has contributed to physician burnout and early retirement.

Who will speak for anesthesiologists, our patients, and our profession? Who will present our side to elected officials? Who will object to the overreach of regulatory agencies?

Can you rely on your employer to safeguard your profession and do what is best, long-term, for anesthesiology? Are they committed to the education of trainees, research to continually advance the science, and protecting the health of our most deserving patient population – America's Veterans? Possibly they are. Maybe you can rely on your hospital, health care system, or ambulatory surgery center? Maybe you should trust them to monitor and activate the legislative branch, the residency training programs, and the licensing authorities to address this vexing workforce shortage? And, of course, the facilities are intimately concerned with your quality of life and work-life balance, right? Will your hospital have your back when the CRNAs declare that there is no difference in the care provided by them and you? Possibly they will. My remarks are not intended to disparage any practice/department, facility, or employer. My own anesthesia practice is very savvy and strongly supportive of ASA and the value of organized medicine. But the reality is that these entities may have other immediate concerns and priorities that limit their ability to focus on your professional and personal needs.

If you are completely satisfied that the people you work for will keep your best interests in the forefront 100% of the time and will work tirelessly to promote and defend the things you have spent your entire professional life working for, then I think you can save the $828 on annual dues and rest easy. On the other hand, even if you believe that your employer or your facility will take care of you, is there a possibility that you might change employers or facilities sometime during your career?

You could make a positive decision to join a group of over 57,000 of your physician colleagues. The American Society of Anesthesiologists was created by, and for, anesthesiologists. It is led and governed by anesthesiologists. It exists only to serve the interests of anesthesiologists and our specialty and to promote safety and quality for our patients. It is laser-focused on the things that matter most to you now and that will affect you for the future of your career. The society has strong tools, including the nation's largest physician political action committee (PAC) – even larger than the AMA's PAC. ASA's membership and leadership work for all subspecialties and modes of employment, including private practices and academic departments, and military and Veterans organizations. ASA is continually focused on renewing and vitalizing our specialty. We have our short-term efforts focused on today, but we have our long-term vision focused on advancing the practice and securing the future.

$828 is a lot of money, but if that's the price for protecting the things you have spent your career working for, then maybe it's worth it? I can't answer that for you. But what I can do is promise that if you join us, your dues money will always be used thoughtfully. We will be here for your entire career. We will always be anesthesiologist-led and responsive to the needs and interests of our members and our patients. You will never have to wonder whether we have competing interests or whether we are working continually for the specialty.

If what I've written strikes a chord, help us help you. Together, we can. And together, we will: asahq.org/member-join.

Patrick Giam, MD, FASA, ASA First Vice President, Physician Partner, U.S. Anesthesia Partners, Assistant Professor of Clinical Anesthesiology, Houston Methodist Academic Institute, and Clinical Assistant Professor (Adjunct), Texas A&M School of Medicine, Houston, Texas.

Patrick Giam, MD, FASA, ASA First Vice President, Physician Partner, U.S. Anesthesia Partners, Assistant Professor of Clinical Anesthesiology, Houston Methodist Academic Institute, and Clinical Assistant Professor (Adjunct), Texas A&M School of Medicine, Houston, Texas.

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