Alexander A. Hannenberg, MD, who will become president of the American Society of Anesthesiologists during its annual meeting in October, discusses 10 facts that every surgeon or hospital executive should know about anesthesiologists.
1. We are very attuned to OR efficiency. Anesthesiologists are looking at the entire operation of the OR, from pre-op through post-op. Because we are personally concerned with keeping the enterprise on schedule, we have become efficiency experts. If things slow down pre-op or post-op, it affects the whole OR schedule. Since our concerns are so closely aligned with those of the hospital, hospitals are increasingly appointing anesthesiologists to manage OR operations.
2. We have unusually low Medicare and Medicaid reimbursements. Medicare and Medicaid typically pay below commercial rates, but nowhere is the difference so profound as in anesthesiology. While Medicare generally pays 80-85 percent of commercial rates for physician services, the figure is only 30-35 percent for anesthesiologists. Therefore, hospitals in communities with large numbers of Medicare beneficiaries have had to subsidize anesthesia services, paying stipends to anesthesiologists.
3. We work in increasingly more settings. In addition to the hospital OR, anesthesiologists now work in ASCs and in cardiology, endoscopy and imaging sites, to name a few. This profusion of sites increases demand for our services and, because we have to travel to different sites, diminishes our efficiency.
4. We are in tight supply. Anesthesiology residency programs are just getting back up to the numbers they had in the early 1990s, before there was a panic about an impending nationwide glut of anesthesiologists. This panic prompted the supply of new anesthesiologists to take a nosedive. We've seen a 50 percent increase in anesthesiology residents in recent years, but that's not really growth; it's a recovery.
5. We face more serious shortages in the future. Recent physician supply studies predict serious shortages not just of primary care physicians but also of specialists, including anesthesiologists. Not only will an aging population need more surgery, but health reform would greatly expand demand for anesthesiologists and other specialists. When everyone has to have insurance, the immediate effect would be a great uptick in demand for primary care physicians because the newly insured would seek out a doctor for their general care. But later, when these same people actually need care, they will be seeking out specialists and that will put our specialty in very short supply.
6. We need to continue medically directing non-physician anesthetists. Greater demand for anesthesia care should not diminish the medical role of the physician. Anesthesia care teams, including certified registered nurse anesthetists and anesthesiologist assistants, who are PAs, will be key to delivering care. Both groups are capable physician-extenders when under the medical direction of an anesthesiologist.
7. Rural hospitals need us, too. Medicare currently reimburses rural hospitals with low volumes of surgery for CRNA services without anesthesiologists. We at the ASA believe Medicare should offer similar support to anesthesiologists so that these rural communities can also benefit from physicians' care in anesthesia services.
8. We are embracing clinical outcomes data. The ASA supported the work of the Anesthesia Quality Institute, which has established a national clinical outcomes registry to identify patterns of adverse anesthesia outcomes and allow anesthesiologists to benchmark performance with peer is starting to materialize. We think it will be a valuable tool for quality improvement, using scientific investigation to establish best practices.
9. Anesthesia is ripe for information technology. Anesthesiology is even more adaptable to information technology than other areas of healthcare because perioperative information derived from anesthesia monitoring systems is basically a collection digital data. When these data are aggregated, they are a powerful tool to study patient outcomes and responses to anesthesia care. We are making great strides to achieve interoperability between different systems so that all this information can be connected.
10. We need more funding for research. Anesthesiology lags behind other specialties in research funding from the National Institutes of Health. Critical clinical issues within the specialty — such as cognitive dysfunction, chronic pain and awareness — demand aggressive investigation.
Learn more about the American Society of Anesthesiologists.