The ASA Fiddles While Anesthesiologists Are Getting Burned

The American Society of Anesthesiologists held their annual meeting last weekend in beautiful San Diego, CA. From all reports, it was a great success. They held an opening day reception on the field at PETCO Park. There were the usual lectures on dealing with difficult airways, difficult patients, and difficult colleagues. Good times were had by all.

But while the party was happening in sunny San Diego, storm clouds are brewing over the nation's anesthesiologists.  Colorado recently became the sixteenth state to opt out of Medicare's requirement for physician supervision of CRNA's. In a public statement, the ASA, "expressed its grave disappointment with the election-year decision of Colorado Governor Bill Ritter to exempt his state from Medicare's longstanding patient safety standard providing for physician oversight of anesthesia services." The statement goes on to assail the governor as a "lame-duck" who went against the strong wishes of doctors and patients in the state.

None of this drama appeared to trouble the celebration at the annual meeting. The president of ASA, Dr. Alexander Hannenberg, gave a written interview on the accomplishments of the ASA over the past year. The Medicare opt out problem was not even mentioned. While perusing through the meeting's thick course catalog, I didn't notice a single talk about the dangers of CRNA's practicing independently of anesthesiologists. Not one breakfast meeting, panel discussion, or symposium was held on how anesthesiologists are slowly and inexorably losing their profession to nurse anesthetists.

By contrast, the nurses really have their acts together. They trumpet their self-sponsored "studies" that tout the safety of their practices that are readily picked up by the mass media. They have strong state and national organizations that are able to persuade government officials to see these issues their way over the objections of the states' doctors. The CRNA's even have meetings that teach the proper method for developing relationships with elected officials.

Where is the urgency to hold back this onslaught? While the ASA elite mingle and laugh it up, anesthesiologists are inexorably being corralled into isolated urban hospital settings. In the meantime the suburban and rural jobs, where two-thirds of surgical cases are done, are being usurped by CRNA's. The ASA calls these opt out decisions by the likes of Gov. Ritter and Gov. Schwarzenegger politically motivated. That raises the troubling question of why the ASA and physicians in general are so politically disconnected and impotent when compared to the AANA, the trial lawyers, or the government employee service unions. The ASA trumpets their accomplishment in reversing the Medicare teaching rule bias against anesthesiology residencies, but if these residents don't have anywhere to practice when they graduate, the whole battle would have been Pyrrhic indeed. We can try to convince the CMS about the unfairness of Medicare reimbursements to anesthesiologists, but at the end of the day, if we don't have jobs to go to, the viability of anesthesiologists will be in doubt.