Watching and working in ASA officer election campaigns for the past several years has been a deeply unsettling experience.

The ASA’s officers today are outstanding anesthesiologists, dedicated to their profession and to the organization. But the process of electing them, from my viewpoint, is a dysfunctional endurance test, fraught with barriers to entry and hobbled by tradition.

Imagine a hybrid of ritualized Kabuki theater and a high-school campaign for homecoming queen, and you’d be close. And yet the results have binding effects on a 50,000-member, multimillion-dollar specialty society whose work affects the professional lives of all ASA members.

We need to reevaluate and redesign this system sooner rather than later for the health and long-term future of the organization. Here is a glimpse of some of the fundamental problems.

While in theory offices come open for election every year, in reality it’s taboo to challenge an incumbent officer.

There are no term limits. An incumbent officer can be reelected indefinitely. So anyone thinking about running for office has no certain knowledge of what year an office may become vacant.

People may announce their intention to run for a given office years in advance of when the office is likely to become vacant, with the intentional effect of discouraging anyone else from running in opposition. (Think of dogs marking their territory.)

The campaign process is prohibitively expensive at personal cost to the candidates, often involving travel to multiple state society meetings. The cost alone is a barrier to entry for younger physicians, as is the time away from work and family.

Read the Full Article


Dr Jef

Thank you for taking this up Karen. I appreciated your details of a process unknown to any who aren't or haven't been direct participants. I found myself asking not about Al Gore or other trifles, but about the Core Mission of the ASA. What DOES the ASA do in reality for me as the practicing Anesthesiologist? I've been both a member and non member. I've read the mission statement. I know what issues they talk about taking up. I've sat in many caucus ...Read More


This was a very enlightening article. I’ve grown increasingly disenchanted with the ASA this year and worry that it is moving away from its member-centric roots. It’s interesting that you bring up the financial aspect of campaigning. I think anesthesiologists need organization and advocacy, but the ASA seems increasingly focused on corporate partnerships to bring in more money. Money is great for advocacy, but not if it compromises the organization’s commitment to its members. I can’t help but wonder how ...Read More


For several years now, I’ve been the social media curmudgeon in medicine. In a 2011 New York Times op-ed titled “Don’t Quit This Day Job”, I argued that working part-time or leaving medicine goes against our obligation to patients and to the American taxpayers who subsidize graduate medical education to the tune of $15 billion per year.

But today, eight years after the passage of the Affordable Care Act, I’m more sympathetic to the physicians who are giving up on medicine by cutting back on their work hours or leaving the profession altogether. Experts cite all kinds of reasons for the malaise in American medicine:  burnout, user-unfriendly electronic health records, declining pay, loss of autonomy. I think the real root cause lies in our country’s worsening anti-intellectualism.

Read the Full Article


The cult of martyrdom in medicine, which insists on passing each generation's cross onto the next (weighed by heavier debt burdens), has gone from being considered an unhealthy but tolerated rite of passage to a dangerous hazing ritual. Add to this a new desire to enjoy quality of life by younger docs (The nerve! How dare they insist on knowing their children!) and you have a financial independence movement within medicine that is understandably appealing to many young graduates. Just prior to my clinical rotations in medical ...Read More
I do remember a lot of these times. I'm not happy about all the changes. Socially I'm very laid-back and informal but I think things at work should be more formal and professional. On the other hand, I don't spend any time longing for the past. Most of the changes are for the better. We focus on the patient experience more. We work as a team for better outcomes. Those old respected medical sages didn't really practice great medicine! ...Read More


This article appeared first in “The Conversation” on April 25, 2018, under the title “Why it’s so hard for doctors to understand your pain”. 

We’re all human beings, but we’re not all alike.

Each person experiences pain differently, from an emotional perspective as well as a physical one, and responds to pain differently. That means that physicians like myself need to evaluate patients on an individual basis and find the best way to treat their pain.

Today, however, doctors are under pressure to limit costs and prescribe treatments based on standardized guidelines. A major gap looms between the patient’s experience of pain and the limited “one size fits all” treatment that doctors may offer.

Read the Full Article


Max Thomas

Someone close to me suffers from both mesothelioma and Parkinson's disease. I understand the pain by way of metaphor. It is like a sea with islands of different shapes and sizes representing the various types of pain. Some treatments or doses flood over the lower-lying 'islands' while other pain peaks continue to 'break through' the surface. The treatment consists primarily of opioids in one form or another. The prospect of the peaks becoming higher is very troubling but there seems to be little to offer ...Read More

Read All 1 COMMENT

Once again, it’s Physician Anesthesiologists Week, and it’s a great time to celebrate our specialty’s many successes and accomplishments.

But we’re wasting an opportunity if we don’t also take this week to consider the state of the specialty today, and what it could or should mean to be a physician anesthesiologist 20 or 30 years from now.

There is no question that a seismic shift is underway in healthcare. Look at how many private anesthesiology groups have been bought out by—or lost contracts to—large groups and corporations; look at how many hospitals have gone bankrupt or been absorbed into large integrated health systems. Mergers like CVS with Aetna are likely to redefine care delivery networks. Where does a physician anesthesiologist fit into this new world?

An even better question to ask is this: Is your group or practice running pretty much as it did 20 years ago? If so, then my guess is that you are in for a rude awakening sometime soon. One of two scenarios may be in play:  either your leadership is running out the clock until retirement and in no mood to change, or your leadership hasn’t yet been able to convince your group that it can no longer practice in the same expensive, antiquated model. As one academic chair said ruefully, at a recent meeting, “They’re like frogs being slowly boiled. They just don’t feel what’s happening.”

Read the Full Article



Thank you for sharing your thoughts on the specialty. I know for myself, it is so easy to get overwhelmed and bogged down by the day to day commitments and stressors, that it can be hard to step back and take the 20 or 30,000 ft view of medicine and anesthesiology. Would love to hear more about the discussion and find a way to be involved in shaping our future!


Very useful and scaring description! I see it so intricate that it's many diversified steps involved, exposes many places to have an accidental mistake with no clear responsible or even detecting easily where in the line the error happened. Isn't it expensiver than the old one man model? Thanks!


Avoiding #metoo in medicine

Let me say first that any woman who has ever been harassed or assaulted should NEVER be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can be toxic.

I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve had ample reason and plenty of time to think about strategies to deal with harassment, parry a verbal thrust, and maneuver out of a potentially humiliating or harmful situation.

We’re lucky in medicine that we have intellectual qualifications — board scores, professional degrees — that are our primary entryway into medical school and residency programs. We’re not being judged PRIMARILY on our looks. Yet many social media comments recently have underscored the fact that some women in medicine have endured ridicule, harassment, and even assault in the course of their careers. It makes sense to explore any tactic that can help other women avoid similar painful encounters.

Here are some tips — learned through long experience. My hope is that they might help younger women in medicine feel less like potential victims, and more like strategists in a behavioral chess game.

Read the Full Article


Yes, it’s unfair that women have to think in self-protective ways while men don’t. It would be lovely if the world were a perfect place, but it isn’t and won’t be. It makes more sense to be smart and in control than to have the unreasonable expectation that life will change immediately just because Harvey Weinstein has been disgraced.


As a young physician working in the emergency department I found this to closely mirror the habits I've adopted. Some of it I think is basic professionalism, and it never hurts to remind people that acting professionally does help people treat you in a professional manner. But some of it is boots-on-ground practical advice about navigating some of the terribly inappropriate things that happen when you are a woman working in the settings we work in. I think you made it clear that it would ...Read More

Read All 18 COMMENTS