Posts Tagged ‘American Society of Anesthesiologists’

Elegy for giant conventions

ANESTHESIOLOGY 2019 may have been the last old-school, convention-size, professional meeting I will ever attend. I could be wrong, but it may mark the end of an era. Disruptive change to the convention business model was inevitable, though hastened by COVID-19. On June 5, ASA leadership announced that the 2020 annual meeting will be virtual — for the first time, but perhaps not the last. Does this news herald disaster or opportunity?

When I was a resident attending my first ASA annual meeting, the huge convention center struck me as the mother lode of anesthesiology knowledge, with lectures and workshops that couldn’t be found anywhere else. Today, I wonder why I would travel across the country to attend a refresher course lecture in a freezing-cold meeting room, when I can watch similar content on YouTube or VuMedi for free, in comfort?

Professional associations could take this moment to move decisively into the video/podcast market. Speakers could record their own lectures, pro-con debates, and panel discussions, and societies like ASA and CSA could post all the content on proprietary video and podcast channels for members to access year-round. Think of the money we could save in travel and the cost of renting convention centers. Giant conventions at the ASA level are limited to only a few cities, most of which wouldn’t be my choice to visit.

The future of exhibit halls?

Corporate interest in buying exhibit space at anesthesiology meetings was fading fast, even before COVID-19. Why pay to send people and equipment to exhibit halls when mergers and acquisitions have centralized all the purchasing power? As recently as ten years ago, many anesthesiologists were able to influence which laryngoscopes or epidural kits their departments would order. Today, people who negotiate purchasing contracts typically work in the central offices of health systems, not in operating rooms. Today, most of us can do little more than complain about our inadequate stock of video laryngoscopes or the maddening electronic health record we’re compelled to use.

Corporate executives aren’t stupid. They know that meeting organizers now have to beg or bribe attendees to visit exhibitor booths. Why spend time at a booth when there is little chance that you can persuade anyone to order the product – especially if it costs more than what you currently use? As exhibitor revenue drops, it becomes harder for a convention to make money or even recover its costs.

What about virtual governance meetings?

Can nonprofit association governance be carried on in electronic meeting rooms? Can Zoom or Microsoft Teams work just as well for the debates of a Board of Directors, or the election of officers by a House of Delegates?

My answer to those questions is a resounding “no”. This is one area where in-person meetings are worth the time and money.

As an example, look at the California Society of Anesthesiologists (CSA). In June, we held our main House of Delegates meeting via Zoom due to COVID-19. We accomplished our tasks,  discussed resolutions, and recorded our votes with no problem other than Zoom fatigue. But I realized afterward that the biggest advantage we had in working through every issue was the fact that many of us weren’t strangers. We had met in person so often before. The hallways and hotel lobbies of past CSA meetings were where we discussed ideas, worked out compromises, and cemented the relationships that are at the heart of politics. Those relationships worked in our favor again.

All politics are local and personal. None of the candidates in our two contested elections had the chance to meet personally with CSA delegates, creating a problem for new delegates who might not know them. Reading a candidate’s personal statement and listening to a well-rehearsed speech have about the same relationship to reality as my Facebook posts have to my day-to-day life.

How do you really get to know a candidate, whether at the CSA or ASA level? By means of personal interaction. When you’re new to a group, which person looks right through you when you’re unknown, then suddenly becomes your new best friend once you gain some standing? That’s not the person who should get your vote. We remember, and vote for, the people of character who earn our friendship and trust. It’s tough to judge character via Zoom.

Which way to the future?

The mission of professional associations is not to host conventions but to serve members. Most ASA or CSA members can’t easily leave work to attend a five-day meeting, especially if it requires cross-country travel. Looking into my crystal ball, I can envision different, leaner anesthesiology meetings.

As an example, a smaller annual meeting of the ASA House of Delegates – in person – could focus on ASA governance, election of officers, finances, and political issues. ASA leaders, state society leaders, and future leaders could get to know each other, and build connections with key people in state and federal government. This meeting would fuse the October annual meeting and the spring legislative meeting at substantially lower cost.

The ASA’s excellent hands-on workshops could move to the state level, supporting the growth and success of state component societies like our own CSA. Their development could be supported by ASA – on practical topics such as point-of-care ultrasound, regional blocks, and advanced airway management – and workshops could be held at state or regional meetings. If meetings were held on weekends and involved less travel, more members would be able to take advantage of them. Membership thrives when an event attracts local interest, and district leaders can meet and recruit members in person.

We hear time and again that anesthesiologists want stronger advocacy and a more compelling message to the public about anesthesiology’s irreplaceable role in healthcare. They want more convenient, on-line education. They don’t want their dues to fund cumbersome committees that meet once a year, and gala receptions that most will never attend.

At a time when elective surgery has been on hiatus, and many anesthesiologists have gone without work, members want their professional societies to focus on securing support for physicians and the practice of medicine, and promoting anesthesiology’s position at the head of the care team. Except for the nostalgia, how many of us will miss navigating those giant convention halls? Maybe the time has come to make the break.

Author’s note:  Destination meetings, like the NYSSA Post-Graduate Assembly in Manhattan, and the CSA Hawaii meetings, have a bright future. They combine education, networking, and family-friendly leisure time in one package, and can be held in hotels, not giant convention centers. 

Tech entrepreneur Josh Linkner gave the keynote speech at this year’s ASA annual meeting in San Francisco, delivering a rousing talk designed to leave the audience inspired with a can-do attitude and new hope for the survival of anesthesiology as a profession.

It should be a good talk; Mr. Linkner clearly has given it plenty of times. According to national speakers’ bureaus, the 48-year-old “innovation and creativity speaker” and “New York Times bestselling author” charges from $30,000 to $50,000 a pop for his keynote addresses, and guarantees a “fast-moving and entertaining” experience for listeners with “real takeaway value.”

So what did we get for our money?

We learned from Mr. Linkner about five “big ideas” that he believes are the keys to driving innovation in any field:

Every barrier can be penetrated

Video killed the radio star

Change the rules to get the jewels

Seek the unexpected

Fall seven times. Stand eight.

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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.

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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.”

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The real surprise – to me, at least – came more than halfway through Dr. Atul Gawande’s keynote address at the opening session of the American Society of Anesthesiologists’ annual meeting in Boston.

Much of his talk on October 21 celebrated the virtues of checklists and teamwork, topics that have turned into best-selling books for the well-known surgeon and professor of public health. “We are trained, hired, and rewarded to be cowboys, but it’s pit crews we need,” he said.

Then Dr. Gawande posed this question to the packed room: “What are the outcomes that matter?”

He answered his own question somberly. “The most unsafe operation is the operation that shouldn’t be done,” Dr. Gawande said. “Does the operation serve the patient’s goals or not?”

“We’ve all been there,” he continued. “Taking people to the operating room and wondering what we’re doing.”

Those are comments I’ve heard from anesthesiologists many times before, but I never thought I’d hear them from a surgeon.

Flogging the dead

For any of us who practice anesthesiology in a major hospital – doing cardiac, thoracic, or liver cases, for instance – there are days when all our efforts are spent on behalf of a patient whose health is unsalvageable. “Flogging the dead” is a phrase sometimes used to describe prolonged and futile care in the operating room or ICU.

Sometimes aggressive interventions are driven by a family that wants “everything” done, because in their innocence the family members have no idea how terrible and dehumanizing the process of postponing death can be.

In other circumstances, however, the decision of whether to do surgery is driven by the mission and the financial motivation of the health system to provide care. If care doesn’t occur, if the surgery isn’t done, no one gets paid.

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