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asahq.org Summer 2016
ASA Legislative Conference Recap Irecentlywasaffordedtheopportunitytoa4endtheASALegisla9veConferenceinWashington,D.C.aspartoftheFloridaDelega9on.ThiswasmysecondtriptotheLegisla9veConferenceanditcouldnothavebeenabe4erexperience!Itwasajam-packedtwoandahalfdays,filledwithengagingtalksfromsomeofourna9on’spoli9calleadersaswellasanumberofveryproduc9vemee9ngsonCapitolHillwithourstate’slegislators.I’dliketoreviewtheeventsoftheconferencefollowedbywhatIbelievetobethemostimportantmessagesthatI’vebroughthometosharewithmycolleagues.
TheconferencebeganonMondaywithareviewofthestructureandorganiza9onofthelegisla9vebranch,legisla9veprocess,andgeneralguidelinestoasuccessfulHillvisitbyNoraMatus,ASA’sDirectorofCongressionalandPoli9calAffairs.JasonHansen,ASA’sDirectorofStateAffairs,thenprovidedawonderfuloverviewofcurrentstatetopicsincludingopt-outs,painmedicine,anesthesiologyassistants,andtruthinadver9sing.Thiswasfollowedbyaninterac9vepanelonadvocacyskillsledbyDr.KennethElmassian,Dr.JohnZerwas,Dr.TomGeorge,andDr.SamPage.Drs.Zerwas,George,andPagesharedstoriesreflec9ngontheir9mespentasstaterepresenta9vesinTexas,Michigan,andMissourirespec9vely.Monday’ssessionconcludedwithaninterac9vepanelonstatetopicsledbyDr.ErinSullivan,Dr.SherifZaafran,Dr.RandallClark,andDr.JeffreyPlagenhoefcoveringout-of-networkpayments,anesthesiologyassistants,andupcomingstateadvocacypriori9es.
TuesdaymorningkickedoffwithphysiciananesthesiologistandU.S.CongressmanAndyHarris,memberoftheU.S.HouseCommi4eeonAppropria9ons,providinganinsider’supdateonhealthcaretopicsbeingdiscussedonCapitolHill.Amongotherthings,heemphasizedtheVANursingHandbook;growingna9onalhealthexpendituresandtheireffectonthefederalbudget;theimportanceofbiomedicalinnova9on;theAffordableCareAct;drugshortages;andlookingaheadtothe2016elec9ons.CongressmanHarriswasfollowedbyManuelBonilla,ASA’sChiefAdvocacyOfficer,whoprepareda4endeesforourHillmee9ngs.MichaelBobcelli,DirectoroftheWhiteHouseOfficeofNa9onalDrugControl
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Run for Office
C a l l f o r a p p l i c a 9 o n s f o rt h e 2 0 1 6 - 2 0 1 7 R e s i d e n tComponent (ASARC) GoverningCouncil-DueSeptember1,2016
Interested? Click here or visit theASAResidentComponentWebsite
TheASAResidentComponenthopesyouwilljoinusinsupportofourthreeprimarygoals:
1.Toencourageresidentpar9cipa9oninASA •JoinASAandlearnabouttheASAResidentComponent•GetinvolvedintheASARC•RunforanofficeontheResidentComponentGoverningCouncil•Mee9ngandeventinforma9on2.Todevelopexperienceinorganizedmedicineamongyoungphysicianleaders•Becomealeader:ASARCleadershipopportuni9esareavailable•Publishyourthoughts:WriteaResidentReviewar9clefortheASAMonitor•ApplyfortheResidentResearchEssayContest3.ToimproveresidentawarenessoftheASA’sroleintheevolu9onofthespecialtyofanesthesiology •Viewinforma9ononresidencyandfellowshipopportuni9es•Discoverawealthofresidentresourcesandlinks•LearnabouttheASAPACandhelpincreaseyourprogram’spar9cipa9on•SingleGraduateMedicalEduca9onAccredita9onSystem
The Official Newsletter of the ASA Resident Component
NEWSLETTER
ConnectwithASAonLinkedIn,Facebook,Twi/erandYouTube
asahq.org Summer 2016
Policy,thenspokeabouttheongoingopioidepidemicandwhatisbeingdonetofightit.WeheardfromCongresswomanJuliaBrownley,co-sponsorofthebipar9sanBenishek(R-MI)-Brownley(D-CA)le4ercallingformaintenanceofthephysician-ledanesthesiacareteamwithintheVA.LarrySabato,Founderof“Sabato’sCrystalBall”andDirectoroftheUniversityofVirginiaCenterforPoli9cs,thengaveahighlyentertainingoverviewofthestateofthepresiden9alelec9on.Thealernoonwasfast-pacedwithaseriesofexcellentspeakers.Dr.StanleySteadspokeonevolvingadvocacychallengesinanesthesiology.CongressmanJohnNygren(R-WI)sharedhisstate’sba4leagainsttheopioidepidemic.DianeZuma4o,Na9onalLegisla9veDirectorforAMVETS,gaveanimpassionedspeechsuppor9ngASA’sstanceontheVANursingHandbook.Dr.DouglasFridsma,presidentandCEOoftheAmericanMedicalInforma9csAssocia9on,discussedalterna9vepaymentmodelsandqualityrepor9ng.ASAPastPresidentDr.AlexHannenbergbrokedownthehighlycomplexMACRAhandbook.Finally,thealernoonconcludedwithsomeadviceon(cont’dnextpage)
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Write for the ASA Monitor
We are accepting submissions for the "Residents Review" section of the ASA Monitor. If you are interested in writing an article, please submit the following: • Topic or possible title of article, and • Sample paragraph Potential authors do not need to submit the entire piece, although we will accept full articles as well. Mark and I are happy to help edit and develop your idea if needed. Articles are typically 1000-1500 words. Please visit the ASA website to view our most recently published articles and to get a sense for what we publish. We look forward to hearing your ideas! Sincerely, Elena Koepke M.D., M.B.A. Junior Editor, ASA Resident Component Governing Council UT Southwestern Medical Center Department of Anesthesiology and Pain Management elenakoepke@gmail.com Mark Jensen, M.D. Senior Editor, ASA Resident Component Governing Council SUNY Downstate Department of Anesthesiology Mjensen08@gmail.com
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
This live activity has been approved for 42 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Register today and savegoanesthesiology.org
Be part of the Residents and Fellows Track designed based on where you are in your academic journey.
• Engage with 15,000 anesthesia professionals from around the globe.• Take part in world-class education from thought leaders in the specialty.• Enhance your professional skills.
NEW! Residents’ Leadership WorkshopDo you have what it takes to be an effective leader? This session will explore leadership styles, skills and goals. Engage in discussions and small group activities.
NEW! Subspecialty Panel – Fellowship or Not?Subspecialists representing major anesthesiology fellowships such as pediatric, OB, critical care, cardiothoracic, regional and pain management will present an overview of their subspecialty practice. Get answers to your questions regarding subspecialty training impact on patient safety, the pros and cons of their subspecialty training, practice and job perspectives.
Resident Written Board PrepDiscover the most challenging concepts including frequently missed items (keywords) from the 2016 in-training examination, divided into basic and advanced topics by the ABA. Gain insights from facilitators about study strategies and discuss available study resources and test-taking tips.
Save $100 on registration when you book your hotel room through the ASA housing block.
ASA Membership Matters! Attend ANESTHESIOLOGY 2016 at no charge when you become an ASA member and register online.
Early-bird
rates end
July 24!
Join the conversation #ANES16
Come Together for a Cause
Enjoy a night of fundraising, food and fun with friends benefiting the Anesthesia Patient Safety Foundation, ASA Charitable Foundation, Foundation for Anesthesia Education and Research, and the Wood Library-Museum of Anesthesiology
Hyatt Regency Chicago, Grand BallroomSunday, October 23, 6-10 p.m.
asahq.org Summer 2016
effec9vemessagedeliverybyTheresaHill,ASA’sDirectorofPublicRela9ons,andLeighWagner,SeniorVicePresidentofPublicCommunica9onsInc.AllASAPACdonorsweretheninvitedtoarecep9onattheUnitedStatesBotanicGarden.
WednesdaywasourdayonCapitolHill,whereourbusyFloridaDelega9onwasabletomeetwithfourteenstaterepresenta9ves!
I’dliketoclosewithwhatIconsidertobethetakehomemessagesfromthisvisit.First,andmostimportantly,ourprimaryfocuswasontheVANursingHandbook-nowofficiallyreferredtoastheAPRNProposedRule-whichcompleteditsreviewwithintheOfficeofManagementandBudgetandonMay25waspostedtotheFederalRegistry,openingupthepubliccommentperiod.Forthoseofyounotasfamiliarwiththisissue,allowmetopresentthreefacts:FACT#1:ThisrulewouldrequireCRNAstoprac9ceindependentlywithintheVAsystem,completelyremovingphysiciansfromtheanesthesiacareteam.YouandIwouldnolongerbeinvolvedinthedeliveryofanesthesiatoourna9on’sveterans.FACT#2:Therearenoissueswithaccesstophysician-ledanesthesiacarewithintheVAsystem.
ThoseinfavorofmakingCRNAsindependentaretryingtopushtheissueforwardbyci9ngissueswithaccesstocare.Thisissimplyfalse.Whilewell-publicizedissuesareplaguingveterans’accesstoprimarycareaswellaspsychiatriccare,therearenoaccessproblemswithinourspecialty.TheVAconductedanindependentinternalreviewandonSeptember1,2015published“AssessmentB”whichiden9fied12special9eswithprovidershortages–anesthesiologywasNOToneofthem.Addi9onally,onDecember10,2015theVAreleaseditsannual“MissionCri9calOccupa9onsReport”whichiden9fiedthetenhighestrankinghard-to-filloccupa9onsintheVHA.Neitherphysiciananesthesiologistsnornurseanesthe9stsappearedonthatlist.FACT#3:Thisisnotaboutscopeofprac9ceorsomean9-nurse“turfwar”.
Thisisaboutpa<entsafety.Wearetheul9matepa9entadvocatesanditisourdutytoensurethatourna9on’sveteransreceivethebestandsafestanesthe9ccare.IpersonallyserveintheU.S.AirForce.Iknowsomeofyouserveaswell.Someday,IwillbereceivingmycarethroughtheVAhealthsystem.Iwillexpecttohaveaphysicianoverseeingthemostdangerousthingthatoccursinmedicine:induc9onofamedicinalcomawhileassumingcontrolofmyphysiologicfunc9ons,onlytobringmebacktomybaselineattheendofit.Thisisthestandardofcarethatourcivilianpa9entsexpect.Ifyouhavenotyetvisitedwww.safevacare.org,Iimploreyoutotaketwominutesrightnowanddoso.Onceyouhavedoneso,encouragefiveotherpeople–familymembers,friends,coworkers,todothesame!OnJuly25thepubliccommentperiodwillendandthedecisionwillbemadebyweighingthesecommentspostedonthefederalregistry.
Thesecondtakehomemessagefromtheconferenceisthatifanissuepopsupinyourstate,chancesareithasbeenalreadybeenbroughtupinanotherstatebefore.JasonHansen’steamdoesamazingworkandcanprovideyouwithinforma9onandguidanceonhowitwashandledelsewhere,sousehisteamasaresource!
Lastly,abitofhomework:Therearealimitednumberofcongressionalcommi4eesthatdirectlyoverseeand/orregulatehealthcarepolicy,sorepresenta9vesonthesecommi4eescanbepar9cularlypowerfulallies.IntheHouse,thesecommi4eesare:theCommi4eeonWays&Means;theEnergy&CommerceCommi4ee;andtheCommi4eeonVeterans’Affairs.IntheSenate,thesecommi4eesare:theCommi4eeonFinance;theCommi4eeonHealth,Educa9on,Labor,andPensions(HELP);andtheCommi4eeonVeterans’Affairs.Ifyouhaveacongressmanorcongresswomanononeofthesecommi4eespleasereachouttothemtodayandmakeyourvoiceheardregardingtheAPRNProposedRuleandaskthemtosignontotheBenishek(R-MI)-Brownley(D-CA)le4er!Thelistofcommi4eesandmemberscanbefoundath4ps://www.govtrack.us/congress/commi4ees.
Shane Cherry, M.D. CA-3, University of Miami Health System shanevcherry@gmail.com
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asahq.org Summer 2016
LIFEBOX ChallengeItisnearlyimpossibletolisteverythingASAdoesforusas resident physician anesthesiologists;we olenwriteyouwithentrea9estosupportitsworkonourcollec9vebehalf, whether those efforts pertain to educa9on,advocacy, career planning or other areas that directlybenefitmembers.
Today,we'dliketoaskforyoutopar<cipateinoneofthe most important and successful charitableini<a<ves of the ASA - the ASA Resident LifeboxChallenge.
Lifebox Founda9on is an interna9onal organiza9ondedicated to making surgery safer in low-resourcecountries; the ASA Resident Lifebox Challenge isspecifically focused on providing all opera9ng roomsworldwide with pulse oximeters and training inoximetry. Itcostsamere$250topurchaseoneLifeboxpulse oximetry package, which includes the oximeteritselfaswellasmul9-languagetrainingmaterials.
The Challenge raised roughly $25,000 last year, but,withyourhelp,wecandoevenbe4er.Ifeveryprogramcouldraise just$250,we'dhavemorethan$35,000tomake global surgery safer—think of all of the pa9ents
wecouldhelp!
Thereareseveralwaystopar9cipateinthechallenge: 1 Submitasanindividual;or 2 Collect group dona9ons at an organized event.
Think crea9vely: golf tournaments, bake sales,rafflesorevenapparelsaleshaveworkedinthepast.
Thereisalsoanewstudentsandtraineessec9onoftheLifeboxwebsite.Whatevermethodyouchoose,youcanmake your contribu9on at the official portal: h4ps://www.asacharity.org/donate?cid=2. Be sure to list yourresidency program in the tribute sec9on so that yourins9tu9oncanbecountedinthechallenge!
ContactLifeboxifyouwantinforma9onabouttheirworkor images for slides and presenta9on materials. Thechallenge ends September 1, 2016. The residencyprogramswith the largest overall contribu9on and thelargest contribu9on per resident will be recognized atthe ASA annual mee9ng in October. So, pool yourresources, get some recogni9on for your program, andhelpmakesurgerysaferworldwide!
Sincerely,HaleMcMichael,President-Elect(halemcmichael@gmail.com)DanHansen,President(hansen.daniel1@mayo.edu)
Graduating Residents Resources
For those graduating residents going into practice or Fellowship, please
access our Young Physicians site to learn more about your ASA
membership, benefits and resources!
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asahq.org Summer 2016
TO THE NEXT GENERATION OF PHYSICIAN LEADERS I was recently invited to visit an academicanesthesiology department to speak to the residentsaboutbecomingaleader.Inaddi9ontorecognizingthehonor and privilege of addressing this important topicwiththenextgenera9onofphysiciananesthesiologists,Ihadtwootherini9althoughts:1)Imustbegebngold;and2)Thisisn’tgoingtobeeasy.
I cameupwitha short list of lessons that I’ve learnedover the years. While some examples I included areanesthesiology-specific,thelessonsthemselvesarenot.Pleasefeelfreetoedit,adapt,andaddtothislist;thendisseminate it to the futurephysician leaderswhowillonedaytakeourplaces.
1. First and foremost, be a good doctor. Alwaysremember that we as physicians take an oath. In themodern version of the Hippocra9c Oath commonlyrecited at medical school gradua9ons today, we say,“MayIalwaysactsoastopreservethefinesttradi9onsof my calling and may I long experience the joy ofhealing those who seek my help.” As a physiciananesthesiologist, we care for the most vulnerable ofpa9ents—thosewho under anesthesia cannot care forthemselves. Examples of anesthesiologistswho do nothonortheircallingexist inthenewsandevenscien9ficjournals,butwecannotfollowthispath.
Medicine is, and always should be, a calling.
2. Define your iden<ty. We live in the era of the“provider,” and this some9mes causes role confusionfromtheperspec9veofourpa9ents.Wealsodon’ttendto do ourselves any favors.Howmany9mes have youheard someone say, “Hi I’m [first name only] withanesthesia”? According to the American Society ofAnesthesiologistsnewsle4er,approximately60%of thepublicmaynotknowthatphysiciananesthesiologistsgotomedicalschool.Whileeverymemberoftheanesthesia
care team plays a crucial role, the next level of non-physician provider in this model has one-tenth theamount of clinical training when compared to aphysician anesthesiologist at gradua9on. I’ve wri4enbefore about what I l ove about be ing ananesthesiologist,andbeingthephysicianwhompa9entstrust to keep them safe during surgery is a privilegewhichcomeswithagreatdealofresponsibility.
3.Considerthe“bigpicture.”Thehealthcareenterpriseis constantly evolving. Today, the emphasis is on valueand not volume. Value takes into account quality andcost with the highest quality care at the lowest costbeing the ul9mate goal. The private prac9cemodel ofanesthesiologyhaschangeddrama9cally inthe lastfewyears with the growth of “mega-groups” created byver9cal and horizontal integra9on of smaller prac9cesand some9mes purchased by private investors. In thisenvironment, physician anesthesiologists andanesthesiology groups will have to consider ways theycan add value, improve the pa9ent experience, andreduce costs of care in order to stay relevant andcompe99ve.
4. Promote posi<ve change. Observe, ask ques9ons,hypothesize solu9ons, collect data, evaluate results,drawconclusions,andformnewhypotheses—theseareall elements of the scien9fic method and clinicalmedicine. These steps are also common to processimprovement, making physicians perfectly capable ofsystem redesign. The key is establishing your team’smission and vision, strategic planning and goal-sebng,and regularly evalua9ng progress. Books have beenwri4en on these subjects, so I can’t do these topicsjus9cehere.Inmyopinion,physiciansofferanimportantand necessary perspec9ve that cannot be lost ashealthcarebecomesmoreandmorebusiness-like.
5. Be open to opportuni<es. Thomas Edison said,“Opportunity is missed by most people because it isdressed in overalls and looks likework.” I havewri4enpreviouslyaboutthemeritsofsayingyes.Asaresidentornewstaffphysician, itolenseems impossible togetinvolved. However, most hospital commi4ee mee9ngsareopentoguests.Considergoingtoonethatcoversatopic of interest and volunteer for a task if theopportunity presents itself. In addi9on, manyprofessional socie9es invite members to self-nominatefor commi4ees or submit proposals for educa9onalac9vi9esattheirannualmee9ngs.
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asahq.org Summer 2016
6.Thankyourteam.Takingthefirststepsonthepathtoleadership is not going to be easy. Therewill bemanyobstacles,nottheleastofwhichis9memanagement.Ahigh-func9oning healthcare team of diversebackgrounds, skills, and abili9es will accomplish muchmore thanwhat an individual can do alone. Celebrateteamwins.Respecteach teammember’sopinionevenwhenitdiffersfromyours.
Always remember to thank your team, and do
it early and often. #leadership
Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine @EMARIANOMD
Contact Your Resident Component Governing Council Daniel A. Hansen M.D. President ASA Resident Component Mayo Clinic Arizona hansen.daniel1@mayo.edu
Douglas Hale McMichael, M.D. President-Elect ASA Resident Component
Northwestern University - Feinberg School of Medicine halemcmichael@gmail.com
Chad R. Greene, D.O. Secretary ASA Resident Component Vanderbilt University Medical Center chad.greene@vanderbilt.edu
Linda W. Young, M.D., M.S. Delegate to AMA Resident and Fellow Section University of Texas - Houston linda.w.young@uth.tmc.edu
Michael C. Lubrano, M.D., MPH Alt. Delegate to AMA Resident and Fellow Section University of California - San Francisco lubrano.michael@gmail.com
Mark Jensen, M.D. Senior Resident’s Review Editor SUNY Downstate Medical Center mark.Jensen@Downstate.edu
Elena J. Koepke, M.D., M.B.A. Junior Resident’s Review Editor University of Texas Southwestern Medical Center elenakoepke@gmail.com
�6Thank you for reading! If you are interested in writing for the newsletter, please email the ASA Resident
Component Secretary at chad.greene@vanderbilt.edu
NEW! ApplyToday
Duke University Medical Center
Now accepting applications for this interdisciplinary, transatlantic fellowship in perioperative medicine!
Duke Perioperative Medicine Fellowshipin collaboration with University College London
Start Date: July 2017
Interested? Email Dr. Tim Miller at timothy.miller2@duke.edu
for additional information.
TinyURL.com/DukePeriopFellow
University College London
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