Posts Tagged ‘California 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. 

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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(This post chronicles the recent Los Angeles visit of ASA President Jeff Plagenhoef, MD, and his Grand Rounds presentation at USC. It originally appeared on the website of the California Society of Anesthesiologists. Above, Surgeon General Jerome Adams, MD, MPH, left, with Dr. Plagenhoef.)

“Who kicked whom off the anesthesia care team?” asked ASA President Jeff Plagenhoef, MD, FASA. Which professional association refuses to work amicably with the other, he inquired of his audience at the University of Southern California on September 15, as he delivered a powerful Grand Rounds address to the Department of Anesthesiology.

In his talk, “Professional Citizenship:  Responsibilities Shared by All Anesthesiologists”, Dr. Plagenhoef emphasized that physician anesthesiologists and the American Society of Anesthesiologists (ASA) fully support nurse anesthesia practice within the physician-led anesthesia care team. In his practice as Chair of the Department of Anesthesiology at Baylor Scott and White Hillcrest Medical Center in Waco, Texas, Dr. Plagenhoef works with nurse anesthetists and with certified anesthesiologist assistants (CAAs).

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I wish I knew who coined the term “DRexit” so I could send flowers or a bottle of whiskey as a thank-you gift. There couldn’t be a more perfect term to describe the growing exodus of physicians from our beloved profession, which is turning into a morass of computer data entry and meaningless regulations thought up by people who never touch a patient.

The one bright note on the horizon for me is that physicians are starting to wake up to the trap of MOC, or mandatory maintenance of certification. It’s surprising that the Federal Trade Commission hasn’t recognized already that this is quite a racket, forcing physicians to do CME activities dictated by monopolistic certification boards which profit handsomely.

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“I’m here to say ‘Yes, they can,’ which is different from ‘Yes, they always do,’” says James Moore, MD, President-Elect of the California Society of Anesthesiologists (CSA).

To the contrary, enthusiasm for electronic medical records (EHRs) is part of a “syndrome of inappropriate overconfidence in computing,” argues Christine Doyle, MD, the CSA’s Speaker of the House.

The two physician anesthesiologists (and self-identified “computer geeks”) squared off in a point-counterpoint debate in New Orleans as part of the American Society of Anesthesiologists (ASA) annual meeting, with Dr. Moore defending the benefits of EHRs and Dr. Doyle arguing against them. Dr. Doyle chairs the ASA’s Committee on Electronic Media and Information Technology, while Dr. Moore leads the implementation of the anesthesia information management system (AIMS) at UCLA.

Legibility, accuracy, quality

Dr. Moore defined safety in anesthesia care as “minimizing patient injury resulting from or occurring during anesthesia, and keeping surgeons from harming patients any more than they have to.” He said that computerization contributes to safe anesthesia care by improving legibility, offering clinical decision support with readily available reference information, and providing alerts and reminders.

Computer tracking of the anesthetized patient’s vital signs is more accurate, Dr. Moore said. It prevents the “normalization” of blood pressure that tends to appear on the paper record. Quality reports are easier to generate and outcomes are easier to measure with EHRs in place, he noted. “Postop troponin levels and acute kidney injury are easy to track.”

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