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ASA Monitor Today

ASA Monitor board members and editorial staff discuss upcoming issue themes and their significance to the anesthesiology community. Each issue’s guest editor will preview the upcoming content package and share insight on its timeliness for the industry.

2023 – August 18  |  June  |  May  |  April  |  March  |  February  |  January

August is National Immunization Awareness Month

August 18

National Immunization Awareness Month graphicASA supports the CDC’s National Immunization Awareness Month (NIAM) campaign during the month of August. Anesthesiologists are a critical part of the clinical team that can make a difference in keeping Americans on a routine vaccination schedule.

Stay updated on this topic via CDC resources, including:

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June 2023

Get the tube in, but don’t let the patient crash!

June 20

Illustration of patient and healthcare workers in a hospital roomAirway management performed in nonoperating room settings is associated with an increased risk of complications, with the most frequent being peri-intubation cardiovascular instability (37-43%) Br J Anaesth 2016;117 Suppl 1:i5-i9PLoS One 2020;15:e0233852). Not only is peri-intubation cardiovascular instability common, it is also associated with poor outcomes in nonoperating room patients (Crit Care 2020;24:682; J Intensive Care Med 2022;37:1467-79). Therefore, identifying risk factors for this complication is vital to the success of airway management in nonoperating room patients, including the critically ill.

Based on available evidence thus far, one can synthesize an approach to mitigating peri-intubation cardiovascular collapse during airway management in nonoperating room patients, by evaluating the items described below:

1. Patient characteristics associated with peri-intubation hemodynamic instability: older age, high illness severity score, history of heart failure, or hematologic malignancy.

2. Pre-intubation characteristics associated with an elevated risk: diuretic or fluid bolus administration in the 24 hours preceding intubation; push dose pressor administration or continuous vasoactive infusion pre-intubation; or MAP <65 mmHg, SBP <90 mmHg, or shock index >0.9.

3. Procedural characteristics associated with an elevated risk; for example, intubation in the setting of cardiogenic shock or hemodynamic collapse.

4. Hypotension Prediction Score (PLoS One 2020;15:e0233852).

If the above assessment indicates a heightened risk, consider modifying the airway management technique to include a fluid bolus and/or bolus dose vasopressors pre-intubation while ensuring appropriate personnel and equipment are available to achieve first-past success. Additionally, the choice of sedative hypnotic is likely to impact hemodynamic outcomes, and ketamine, a ketamine/propofol admixture, etomidate, or nothing may yield the most favorable hemodynamic outcomes (Am J Respir Crit Care Med 2022;206:449-58; J Trauma Acute Care Surg 2019;87:883-91; Intensive Care Med 2022;48:78-91; Lancet 2009;374:293-300). When approaching airway management in critically ill adults outside the OR, evaluation of both anatomic and physiologic considerations that may impact outcomes must be undertaken in concert. For more information, read the full article.

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A decade of distractions in the OR

June 1

Surgeon sitting in chair looking at phone

A lot has changed since Anesthesia Incident Reporting System (AIRS), the first specialty-specific reporting system in the United States, was launched in 2011 but one persistent theme is distraction from electronic devices in the OR.

In honor of this anniversary, ASA Monitor presents the original case, and an updated conclusion.

“Computer screen for new electronic anesthesia record froze. During the time of distraction while I was working on the problem, the patient blood pressure jumped 70mm Hg due to increased surgical stimulation, and I did not notice it immediately.”

“Due to focusing on new electronic anesthesia record, forgot to put ECG monitoring on patient before induction.”

The use of an anesthesia information management system (AIMS) has some clear advantages, such as:

  • Creating legible and consistently structured anesthesia records
  • Allowing for real-time data capture and subsequent analysis
  • Improving the timely administration of prophylactic antibiotics and perioperative beta blockers

However, 13 of 632 (2.06%) of the cases in AIRS are related to problems with AIMS, and seven (1.11%) led to intraoperative distraction from patient care. The impact of AIMS on anesthesia clinicians' vigilance, which has received very little attention. While there is a compelling argument that not manually charting vital signs allows the anesthesia team to attend to more pressing patient care issues, the counter argument is that the need to manually chart creates greater vigilance.

In 2012, the recommended future solutions to intraoperative distraction included more effective and intuitive alarm systems, more widespread use of checklists that promote attention to detail, and a better understanding of what distractions should be allowable during anesthesia care. By 2023, the issue of distraction is much more pronounced and accounts for 2% of reports submitted to the AIRS database. The AIRS Committee offered a new recommendation: Minimize the distractions of electronic devices by limiting usage to what is required to deliver the best possible patient care. Read more in the full article.

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May 2023

The affliction of health care wastage

May 26

Earth covered in dirty cloudsThe U.S. wastes more of its health care expenditure dollars than the GDP of Norway and Portugal combined!

The latest issue of ASA Monitor is dedicated to discussions on reducing this wastage from multiple angles. Drs. Umar Kamal, Taysir Awad, and Beenish Khurshid enlighten readers with an article on national drug shortages. They explain how manufacturers’ profitability requirements cause them to venture away from older generic prescription drugs while investing more in pricier branded drugs.

Drs. Korina Katsaliaki, Sameer Kumar, and Kumar Belani talk about the supply chain at the hospital level, the need to involve anesthesiologists in supply chain planning, and how eventually they affect the quality of care provided in ORs. They also address the bullwhip effect and hoarding, which affect hospital supply chains and contribute to increased expenditure.

Dan Vukelich, President of the Association of Medical Device Reprocessors, reiterates the grim warning from the U.N. Intergovernmental Panel on Climate Change on the effect of GHG on the health of humans and the planet. He stresses in his article the crucial impact that medical device reprocessing could have on the supply chain and promotion of a circular economy. Drs. Jane Ahn, Lesley Bennici, and Ana Costa continue to explore this concept in their article, highlighting that one hour of desflurane use is equivalent to the automobile emissions of 200-400 miles of driving. This indeed drives the point home!

This issue is incredibly timely, and our goal is to educate to protect our planet at a global level, to initiate awareness about health care expenditures at the national level, and (hopefully) to persuade you at a personal level to modify your anesthetics to protect our people and our planet. Read the full guest editorial here.

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April 2023

Why Trends in OB Anesthesia Matter

April 28

Guest editor of May’s ASA Monitor Barbara M. Rogers, MD, MBOE, FASA notes that, even on the OB floor, patients are older with more preexisting conditions. Combining pregnancy-specific physiology with hypertension, diabetes, obesity, anxiety, depression, and substance abuse can lead to complications for parturient and baby.

In this issue, “Critical Care of the Crashing Parturient” discusses the obstetric comorbidity index score, as well as the Sequential Organ Failure Assessment score. Point-of-care testing and ultrasound are covered. Yet another article delves into the benefits and shortcomings of two predominant viscoelastic testing systems.

“The Utility of Fibrinogen Concentrate in Obstetric Anesthesia” outlines treatment options for postpartum hemorrhage.

Authors in this issue cover the curriculum in obstetric anesthesia residency programs, doulas, opioid use disorder, high-risk patients, and even the use of 3D printing. Happy reading!

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Updates on the 2022 Opioid Prescribing Guideline

April 19

Spilled over medication bottle of white pillsIn response to widespread debate about the 2016 Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guideline, a revised draft guideline was released in February 2022 for public comment, and a final version was published on November 4, 2022.

The unintended consequences of the 2016 guideline were numerous, and the impact on patients was significant. Clinicians, state legislatures, health insurers, and health care policymakers created wide-ranging and often restrictive prescribing policies that negatively impacted specific populations of chronic pain patients. For prescribers, these policies fueled fears of disciplinary action, concern for iatrogenic opioid use disorder (OUD), and use of opioids in general, and, many might argue, also led to fears of managing any acute and chronic pain (

The extensive 100-page 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain outlines 12 recommendations and presents several new changes in treating pain ( Specifically, it expands guidance for acute (<1 month duration) and sub-acute (one- to three-month duration) pain, discusses the duration a prescription should be filled, eliminates the 90 MME threshold for opioid prescription while emphasizing that doses higher than 50 MME may have a higher risk-to-benefit ratio, and more. Read the full article here.

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Performing complex cases off-hours

April 14

Doctors in the ORMost anesthesiologists can relate to the Anesthesia Incident Reporting System (AIRS) Report “All the Way or Not at All” published in the April issue of the ASA Monitor. Dr. Joyce Wahr, on behalf of the AIRS Committee, submitted a case involving a purely elective—but complex—case on a weekend or at night.

According to the AIRS Committee, it’s relatively common for leadership to request opening rooms for elective cases on the weekend or to do elective cases late into the night on weekdays.

It may make financial sense but anesthesiology departments resist extending “normal” operating hours or doing purely elective cases on the weekend. The economics of greater utilization of any expensive suite are quite plain – the problem arises when additional utilization comes without additional staffing. Reconstructive and multilevel spine surgeries such as the one in the report are frequently complicated by significant blood loss and the need for allogeneic transfusion; spine surgery is one of the procedures most frequently implicated in claims involving massive transfusion (Anesth Analg 2016;123:1307-15). Any time a complex, high-risk case is performed, there should be ancillary support that is equivalent to daytime weekdays.

The article recommends that physicians, when in discussions with hospital leadership who are requesting that anesthesia departments extend their elective surgery coverage deeper into the night and on weekends, ask to be supported “all the way or not at all.” That is, if the ORs are to be run like manufacturing plants 24/7, they need to be staffed in the same way, and the support must be no different at night than it is during weekdays. Multiple anesthesiologists need to be on site, laboratory and respiratory therapy need to be equivalent to daytime requirements, anesthesia technicians need to be present in the same ratio as during regular hours, and so on.

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Pediatric anesthesiology expansion in fastest growing U.S. region

April 12

Drs. Narasimhan “Sim” Jagannathan and Amod SawardekarEditor’s Note: The new Division of Anesthesiology at Phoenix Children’s—one of the fastest growing regions in the country—is the subject of an upcoming ASA Monitor Facility Spotlight. In advance of the issue, Doctors Narasimhan Jagannathan and Amod Sawardekar share their passion for pediatric anesthesiology with Monitor readers.

Working with pediatric patients brings a unique set of challenges, which is what first drew Drs. Narasimhan “Sim” Jagannathan, Phoenix Children’s Division Chief of Anesthesiology and Amod Sawardekar, Associate Division Chief of Anesthesiology, and the Director of Perioperative Services and Operations at Phoenix Children’s, to the field. In addition to the regular complexities of combining pharmacology and physiology, pediatric anesthesiologists must be particularly attentive stewards of their patients. “Pediatric anesthesiologists are advocates because we're dealing with a very vulnerable patient population who really can't voice their opinions or concerns, so those challenges become different in terms of our space. The margins of safety in terms of what we do are different than in the adult world,” said Dr. Jagannathan.

Drs. Sawardekar and Jagannathan hope that the expansion of Phoenix Children’s and the creation of the Division of Anesthesiology will draw more attention to pediatric anesthesiology as a specialty. Since the beginning of their careers, pediatric anesthesiology has come a long way, according to Jagannathan and Sawardekar, and the growth of the subspecialty is represented in their department’s team: “There's been a push for subspecialization under pediatric anesthesiology. Pediatric cardiac anesthesiology is now a recognized fellowship and we do have individuals in our group that provide care in that area. Additionally, there are individuals in the group who have done a chronic pain fellowship for children. We're fortunate enough to have a few individuals who are interested in other clinical spaces, like subspecialties for spine care and craniofacial cases, so they will be capable of taking care of those complex pediatric cases,” noted Dr. Jagannathan.

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The case for reusables

April 7

Forced-air blanket on patient armGiven the supply chain shortages that many geopolitical experts predict may still worsen before improving, author Scott D. Augustine, MD, CEO, founder, and part owner of Augustine Surgical Inc., implores audiences to consider switching to reusable products when they are available and safe.

Nonsterile products such as forced-air warming blankets can easily be substituted with readily available reusable, conductive warming blankets and mattresses. Aside from their other advantages, such as being more effective and cheaper, these reusable warming products are not experiencing supply chain challenges, he argues.

Furthermore, Dr. Augustine notes that 676 forced-air blankets or gowns used in one OR become 200-440 pounds of nonrecyclable plastic waste each year ( The production and incineration of that plastic result in 1,200-2,640 pounds of CO2 (

Read the full article here.

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Rwanda Overseas Training

April 4

ASA’s Global Health Overseas Training Program, in collaboration with the University of Rwanda anesthesiology residency program, has graduated more than 30 anesthesiologists, with many remaining in Rwanda to expand safe anesthesia access.

Rwanda still lacks fellowship training programs for subspecialty expertise. Despite this, some faculty have been able to complete fellowship-level training elsewhere. There is clearly a need to expand critical care capacity and educational opportunities. To address this, Rwanda's health care leadership is making plans to create and expand fellowship training programs – a great opportunity for continued ASA support. Learn how to get involved in Rwanda overseas training.

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March 2023

The role of ASA’s corporate partners in improving supply chains

March 31

In the current supply chain bottleneck, ASA’s corporate partners are stepping in. In the article “Optimizing Patient Care: How ASA Partners Work to Improve Supply Chains and More,” Corporate Relations and Business Development Executive Deborah Greif summarizes the efforts of Fresenius Kabi in making a nearly $1 billion investment in three U.S. plants and distribution centers so their injectable medications are produced and stored in closer proximity to the patients and providers who need them. This investment includes new automation and technologies for expanding production of products to meet the needs of clinicians.

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Mentorship matters when it comes to getting promoted

March 14

Promotion is a natural part of any career in academic medicine, but the pursuit of promotion also comes with many obstacles. Every institution has a unique path to promotion – understanding what that path looks like can help you overcome any barriers you encounter. ASA Monitor spoke with an expert on her own experiences, and what advice she has for those looking to start down the pathway to promotion.

The treasure map

Many physicians expect the path to promotion to be straight and clear, as promotion is an anticipated, natural progression in the course of any career. There is a general promotional path in academic medicine from medical school to residency, training in a subspecialty to placement as a practicing physician. After completing their training, physicians often serve as assistant professors and are promoted to more prestigious positions as their career progresses. Professorship is considered the highest promotional aspiration in academic medicine. The path to promotion at a particular institution, however, can be unique and difficult to navigate without the proper tools: “For academic promotion, I used to naively assume that it is a stepwise process of advancing in rank. Now, even with my recent promotion to Associate Professor, I still feel that the process of academic promotion is mysterious and complex, reminding me of following a map and enduring exciting yet challenging quests to find buried treasure,” shared Dr. Sher-Lu Pai.

Dr. Pai has served as an Assistant Professor of Anesthesiology within the Mayo Clinic College of Medicine and Science since 2015, and in August was promoted to the position of Associate Professor of Anesthesiology and Perioperative Medicine. In the operating room, she is one of the Division of Transplant Anesthesia team members. She is also the Director of the Preoperative Evaluation (POE) Clinic and a diplomat of the American Board of Anesthesiology (ABA). Over the course of her career, she has extensively researched and published work on promotion in the field of academic medicine.

At Dr. Pai’s institution, everyone rises in the ranks in the same general direction. All academic staff begin as instructors and then are promoted to the position of assistant professor, then associate professor, and then professor with a singular academic promotional track. While this pathway is clear and the same for every academic staff member, everyone begins their journey with different tools and resources to follow it. The role of a mentor cannot be underestimated. Mentors provide significant guidance to a physician’s career trajectory and act as a role model. “While everybody gets the same treasure map, some are fortunate to have great leaders, crews, and vehicles to navigate with a clearer sense of direction, while some are alone and unaware of how to seek guidance to start the journey,” said Dr. Pai.

Challenging barriers

Seeking promotion can be an exciting professional challenge to take on, but some systemic barriers can be frustrating and disheartening. While all anesthesiologists face obstacles in their journey to promotion, women and people of color often face additional obstacles, and are even discouraged from seeking promotion in the first place. This discouragement reveals the larger, persisting barriers that women and people of color in anesthesiology, and S.T.E.M. in general, continue to face. Dr. Pai noted, “From studies I’ve found, there are gender and racial differences in promotion, tenure, leadership, salary, recommendation letters, evaluation ratings, and other opportunities in academic medicine.”

Discouragement comes in many forms. Dr. Pai recalls being discouraged from seeking promotion earlier in her career and receiving unsolicited advice and warnings from her colleagues and friends, including being told that she shouldn’t be disappointed if she didn’t receive a promotion, because her institution just has “a busy clinical schedule.” In addition, traditional gender roles can affect how people of different gender identities experience the path to promotion. For people who choose to have children, seeking promotion may be difficult. “Academic success depends on an uninterrupted commitment to career, which may be difficult for some women since the most intensive years for career building are likely to coincide with childbearing years. When a promotion opportunity is presented as an all-or-nothing proposition, the lack of academic productivity in an early career phase may be equivalent to forgoing the chance for later promotion,” noted Dr. Pai. In her research, Dr. Pai found studies reporting that many women do not ask to be promoted to begin with, due to several factors including the challenges of balancing a productive academic career and familial responsibilities. Dr. Pai recalled her own experience with this gendered discouragement, when she was told that she should “go part-time to be a better mom.” When seeking promotion, having a mentor who doesn’t discourage you, but instead supports and encourages your growth in the field is a key to career development. Beyond encouragement, mentors can often act as advocates for their mentees by introducing them to influential people to form relationships that could lead to new opportunities, and by writing letters of recommendation.

Acknowledging that there are inequities in the path to promotion is important as it’s the first step in creating a more equitable and accessible field of academic medicine. Dr. Pai said, “I always remind my two girls that my time away from them is for them. ‘People need to get used to having a lady as a boss,’ I often say to them, ‘and I strive to be a great boss.’ By the time they go into the work force, I hope they will not need to fight the stereotype that they are less competitive just because of their gender.”

A lack of transparency

Dr. Pai said it’s difficult to determine if promotion in anesthesiology is changing, as she’s found that there is significant variability in the pathways to promotion between institutions. What is consistent is a lack of transparency in what those pathways are. Each institution has a different organizational structure and different criteria that must be met to earn promotion. Dr. Pai noted, “The lack of knowledge on the promotional process may be the number one barrier all physicians face. How can you ever reach a goal if you don’t know where you’re aiming?”

The impact of a lack of transparency can be great, as it can even lead to a promotion being denied. “When someone is denied promotion, it is most likely because that person has not met their institution’s criteria. However, when there is not clearly stated promotional criteria at the institution, the reasons will remain a mystery,” said Dr. Pai.

When it comes time to explore promotion, it is critical to understand the academic promotion process at your institution. There were only a few people in Dr. Pai’s department who had been promoted beyond Assistant Professorship, so she saw “the process was as big of a mystery for me as to others.” Dr. Pai contacted physicians outside of her department and specialty to learn about their experiences, and researched literature on promotion. Mentors are invaluable resources for understanding your institution’s unique promotional process, as they’ve successfully navigated the journey already. Available promotions are highly competitive, so understanding the expectations set and having a guide to evaluate your application process will give you a leg up. Mentors can provide honest feedback for your research and portfolio to ensure your application is strong and competitive.

Navigating the pathway

Knowing what resources are available to you can be the difference between achieving promotion or being denied one, so communicating with your leadership is a good place to start. Dr. Pai says there isn’t necessarily an “appropriate” or “inappropriate” time to seek promotion, but she does suggest that a good approach is to talk with leadership about your own individual journey. Asking questions like “Am I ready for promotion?” or “What do I need to do to get ready for my next promotion?” can help you understand how far along you are on the promotional path. Identify mentors and colleagues who can help you understand what resources for preparing a portfolio are available to you at your institution.

Those seeking promotion should also consider what the typical length of time between promotions is at their individual institutions. Dr. Pai noted that “some practices provide a clear timeline between promotions, while some ask for specific requirements without a timeline. For academic promotion, there seems to be a suggested five-year period, but that length of time may also hinder the fair promotion of some physicians with high productivity.”

Many institutions require a promotion portfolio, or a collection of materials that reflect your qualifications for promotion. When preparing a promotion portfolio, Dr. Pai recommended identifying the different impacts of scholarly activities at your institution and incorporating higher impact items into your portfolio. Prior to this, ask leadership to provide you with previous portfolios that led to successful academic promotions. “If you can find the right mentors who have gone through the same process, the real-life expertise will be greatly beneficial,” she added. Although the criteria is unique to each institution, generally candidates for promotion demonstrate consistent reliability and growth in their medical practice, their teaching, research, and their commitment to their facility. Most promotional candidates also have established, positive relationships with both their colleagues and students.

When building your portfolio, don’t shy away from being your own cheerleader. Self-promotion is the first step towards professional promotion – know your strengths, and don’t be afraid to express your interest in promotion to your leadership. “Advocate for yourself. The workplace promotion process is often not automatic. One must do a certain amount of self-promotion to advance their career,” said Dr. Pai.

Most importantly, when one person finds a way to overcome a barrier that could be affecting their colleagues, it is beneficial to disseminate the resources and tools that helped them. Pursuing promotion, while a competitive and difficult process, can be beneficial to the world of academic medicine, as those who achieve it bring insight, recognition, and advancements to their field. Breaking down barriers helps the field of academic medicine grow and progress more rapidly. Dr. Pai enthusiastically noted the importance of holding that door open for those who come after you: “Once you have successfully completed the journey, help others. By working together, the future of anesthesiology will be brighter.”

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4 Reasons Why an Anesthesia Department Should Support the Humanities

March 2

Ronald G. Pearl, MD, PhD, FASA, chair of the Stanford Department of Anesthesiology, Perioperative and Pain Medicine, is well known as a champion of medical arts and humanities. In this March 2023 article, Dr. Pearl establishes a case for any anesthesiology department to support the arts. Read his rationale below:

1. Resident recruitment. The majority of medical students who apply to anesthesiology residency have had accomplishments in areas such as music, literature, painting, photography, and dance, and they find that these areas of creative expression bring enhanced meaning to their lives. They are in a medical specialty that supports continuing involvement in these areas. Stanford Department of Anesthesiology, Perioperative and Pain Medicine activities in the arts and humanities have been a major factor in recruiting medical students into our specialty.

2. Faculty retention. For many faculty, participation in the arts and humanities fulfills that need and allows them to continue their clinical, educational, academic, and administrative activities with greater enthusiasm. In addition, activities such as creative writing or discussion of relevant literature provide important perspectives on our clinical and academic roles, thereby enhancing career development and satisfaction.

3. Diversity, equity, and inclusion. The resulting community enhances our commitment to DEI and helps promote activities to further our departmental efforts in this area.

4. Connecting the department to the medical school and university. Other medical school departments such as medicine, pediatrics, and surgery do recognize the importance of the arts and humanities to their faculty and trainees, and the arts and humanities are obviously an essential component of the university. Therefore, having anesthesiology recognized as a leader in medical humanities elevates the status of the department throughout the medical school and university.

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February 2023

Medical Humanities and the Arts

February 24

The March theme of the ASA Monitor is “Medical Humanities and the Arts.” Guest editor Audrey Shafer explains the significance of this theme: “My hope is that by reading the variety of ideas and perspectives expressed in this themed issue, and through understanding the motivations for creativity here, you will come to realize that what we as anesthesiologists do, and what medical humanities provide, are not so distant from each other. If you are already involved in the work of medical humanities, I hope this issue bolsters your resolve and opens doors for further engagement.”

Read the March issue of ASA Monitor.

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Questioning the Value of “Generations Research”

February 17

GraphThomas R. Miller, PhD, MBA, devotes February’s “Curious Economist” column to the concept of researching characteristics of different generations. His quick search on PubMed shows that generational research has been a topic in the life sciences for more than three decades ( Dr. Miller agrees that certain education, communication, and marketing approaches may be more effective for a particular generation but questions the usefulness of generation research in workforce economics.

Dr. Miller prefers using an economic framework to study anesthesia workforce challenges, especially during perceived shortages. The economic principles that are critical building blocks to a rational and evidence-based framework include individual utility curves, relative pricing, the effect of substitutes and complements in the labor markets, the role of compensating differentials, and diminishing marginal returns. In addition, he believes economic models have superior predictive ability compared to generational profiling.

More on the discussion of generations vs. economics research and information on ASA’s Career Stage focus can be found in “Generations Research of Limited Value in Studying Workforce Economics.”

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Culture Matters When it Comes to Pain Perceptions

February 10

Woman holding her stomach with a pained expressionRetrospective cohort studies conducted by Todd et al. in 1993 and 2000 found that Hispanic and Black patients were considerably more likely than Caucasian patients to not receive analgesics for similar injuries in the emergency department (Ann Emerg Med 2000;35:11-6). These differences in analgesic administration were mirrored by a 2019 meta-analysis that confirmed practices have minimally changed (Am J Emerg Med 2019;37:1770-7).

In the February 2023 article “Cultural Perceptions of Pain: Why It Matters”, we discuss how understanding the factors that mediate these differences is essential in the pursuit of eliminating disparities in pain management. Different cultures’ perceptions of pain are outlined in an effort to promote shared decision making. Implicit beliefs about pain guide patient preference in pain management and have significant impact on quality of life and, at times, prognosis. Until the proportionality of physicians matches the patient population, efforts to raise awareness and understanding of factors contributing to disparities in pain management add to our cultural competency and provide us with building blocks to empathetic, equitable patient care.

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Physician Workforce Diversity

February 1

Physician workforce diversity is more than just a 2023 buzzword. In this February 2023 article, author William A. McDade, MD, PhD, argues that representation of diverse individuals in the physician workforce transcends models of care delivery in its impact on elimination of health inequities. He unpacks the history of this concept, stretching back to 1910. The article discusses ways a more diverse workforce could influence pressing issues in anesthesiology, including adequate pain treatment, maternal mortality, use of epidural care for labor and operative delivery, use of preventive measures for nausea and vomiting, parental presence at pediatric induction, and many others.

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January 2023

Diversity and Inclusivity Coverage

January 27

The February issue of the ASA Monitor is dedicated to diversity and inclusivity, especially in health care. We have chosen a variety of outlets to express our message including online, print, and podcasts. We have a stellar group of contributors in this issue. Some share their personal experiences in the face of adversity, while others review personal efforts to bring about inclusivity.

This issue of the ASA Monitor may not tell you about newer drugs, clinical trials, or any other of the clinical or scientific issues we traditionally address. But it is our hope that this issue increases our understanding of the persistent inequities in our health care system and offers suggestions to create a better tomorrow.

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ASA's cotep addressing opioid epidemic with new naloxone awareness project

January 18

NaloxeneI have had the privilege of being part of the ASA Monitor Editorial Board for a few years, and one article that has touched my heart is the wrenching story of Dr. Bonnie Milas and her efforts in collaboration with the ASA Committee on Trauma and Emergency Preparedness to improve society (ASA Monitor 2020;84:1-8). Even though the article is nearly two years old, its message is unfortunately even more relevant today and resonates with a wider audience of affected family members.

U.S. Surgeon General Vice Admiral Vivek Murthy, MD, MBA, has sent a standing prescription for naloxone to any pharmacy in the country. If you want to know how to get a box for free and save a life today, visit the NEXT Distro website (

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ASA President and Chief Advocacy Officer take a deep dive into the NSA

January 11

No Surprises Act graphicDon’t miss this February Online First article from ASA Chief Advocacy Officer Manny Bonilla and ASA President Michael Champeau, titled How the No Surprises Act Privileges Insurance Companies Over Anesthesiologists – And What ASA Is Doing About It.

In this comprehensive examination of the No Surprises Act (NSA), they explore what the NSA is:

“The federal No Surprises Act (NSA), implemented in 2022, represents an important step forward in protecting patients from surprise medical bills and improving transparency within the health care system.

How the implementing regulations have instead emboldened insurers, to the detriment of physicians:

“One of the most egregious practices we’ve seen is payers leveraging the NSA against community practices to push in-network anesthesiology practices out of network. Practices have reported threats of contract cancellation unless they accept reductions of 40%-60% of previously contracted rates – rates far less than the existing local median in-network contracted rates.

And the steps ASA is taking to address these issues as they arise:

“We are in frequent contact with the Center for Consumer Information and Insurance Oversight with our recommendations, including conducting a long call with them recently to discuss challenges and potential solutions around ‘batching.’”

Don’t miss this and other important Monitor articles in Online First.

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