President's Address: 2013 House of Delegates

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  • Sybert, Peter, MD
| Jun 10, 2013

Editor's Note: This week's CSA Online First is from our 2013-14 president, Peter E. Sybert, MD. He spoke to the 2013 House of Delegates about priorities for the CSA in the upcoming year. Here is his speech. 

Welcome to all of our honored guests, members of the Executive Committee, and especially to you the members of the House of Delegates.

Dr. Pregler has discussed his year as president, and the status of the current activities. As you can see, there is much for us to do and we will continue to work along those lines. A lot of information has also been given to you in prior talks, and I will try not to repeat that information. Today, I want to focus on a few major ideas going forward. They build on past decisions by the House and work done by your Board of Directors. These shifts put us into a proactive position, as opposed the reactive situations and the positions that we’ve been in. They are a response to the times we live in. And what times they are.

Many of us have seen this ad. I never thought I’d see something like this when I first went into practice. I am a physician- anesthesiologist. I certainly have my issues with a lot of what is in the ad. If I was not—and I’ve shown this to several others—it is actually pretty effective. Well why does it work? It works by blurring the distinction between what we do, alleging that we are the same because it looks that way on the surface. The ad tries to redefine us. It plays on perception.

Well how many people really know what differences exist? The AMA ran a survey in 2010 on what the public knew about who was a physician. Anesthesiologists fared relatively well, where 78 percent of people recognized us as physicians. Of course, that meant that 22 percent either did not know that we are physicians, or were not sure. That was certainly much better than how the ENT physicians fared, where only 43 percent of those surveyed knew they were physicians. But down at the bottom is the doctor of nursing practice, and certainly that’s an area of controversy. A third of people thought they were physicians. Only 46 percent of people in the survey knew that they were not physicians. And it is not just the general public that is confused and uncertain.

A few years ago, our group was looking to hire somebody to help with the scheduling. We wondered who could deal with the chaos that exists in an expanding group’s schedule. We thought of one of our tertiary care centers that deal with trauma — and the secretaries who work at the front desk there. We found a young individual who really thrived on the chaos we know exists there. We hired her. After she worked for us for a while, one day she turned around in her chair and asked: “Dr. Sybert, I hope you don’t mind, but how does your training compare with that of a physician?” I’ll tell you, I was blown away. This is somebody who is bright, hard working and worked around us for years...and didn’t know. Well if she doesn’t know, others don’t know either.

But that isn’t the only thing with this ad. I think there is something missing. The more I looked at it, the more it occurred to me that something big is missing. Where is the patient? There is no patient here, and patients are at the center of clinical anesthesiology. Without patients, there is no clinical anesthesiology. There is no patient here. What do patients need to know when they see ads like this so they don’t get confused about blurring lines and defined roles. Well one place to start would be the “To Err is Human” IOM study.

We have all seen the data, but what’s really striking, and what’s always struck me, is that that is an approximately 50-fold decrease in mortality. That is actually stunning. How many people really know about this? That was a contribution that was led by physician-anesthesiologists and others need to know of our successful track record: patients, payers, employers, legislators, frankly everybody needs to know. And the evolution has continued since then, as we know from the literature — much of which you write, and all of which we read.

We all know though, that for a long time, surgeons’ reputations were based in part on their speed of performing a surgery. Well that time has now passed, in part because of modern anesthesia.

For me, it has been a pleasure to be a part of modern anesthesia. It goes to the heart and soul of medicine, the relief of pain and suffering, the continuous improvement of patient care, safety and even survival. Physician-anesthesiologists have led clinical work and have a terrific track record. It has involved changes across everything that we do, from pharmacology, to monitors, to techniques, to the development of guidelines and practice standards, even formation of groups and structures. Change has been a constant in our professional lives. It has benefited our patients greatly, and it has prepared us, I think, for change that is coming. And change is coming.

You have heard already, and you know because we live it, that California is an opt-out state. PPACA is signed national legislation. The US Supreme Court held up PPACA, and President Obama has been reelected as president. What change is coming, though, is uncertain.

There was a NY Times editorial late last month, that said in part, “...regulators have been working hard but are clearly overwhelmed, trying to write rules that influence the entire health care system, an economic unit roughly the size of France.” Senator Max Bauccus, one of the authors of the Affordable Care Act, says he sees a ”... huge train wreck coming” in the implementation of this law. These are uncertain times, and it is uncertain what is going to happen, but we can’t leave ourselves to be defined by others. We must make others aware of our contributions, our record of success, the value physician-anesthesiologists have brought and continue to bring to bear for patients, payers, hospitals, facilities, everywhere we interact. Because it is really uncertain how things will evolve.

Johns Hopkins University has started an advanced practice nursing program to train GI nurses, with the same number of endoscopies that the GI Fellows perform. It is not just anesthesiology that is seeing change. Change is coming across all of medicine. This is great, because we’re going to have lots of allies in these discussions. Where it will end though, will be defined in the scope of practice laws in each of the states. As you have already heard in other talks, California has close to 20 scope of practice laws before the legislature—three major ones that are being discussed. Across the nation there are over 250 scope of practice bills that have been introduced in 47 states. And it’s not just an in-state debate.

The FTC has weighed in as well. In response to why they are involving themselves in health care, a portion of the response read, “...What justifications might exist for any restrictions on competition, and whether less restrictive alternatives would adequately protect consumers.” I don’t know what “adequately” means in this setting. When was the last time you planned a day of adequately-performed anesthesia. Certainly the patients I deal with aren’t looking for adequate care: They are looking for great care. The FTC has offered their opinions in several states, and I expect there is more to come.

The times that we find ourselves in make it necessary to be proactive, so that when others are looking to define the relationships, we make sure that our perspectives are heard. And that brings me to our CSA.

First I would like to thank all of those who have worked hard to make this Society what it is today. Many of those people are here today, and many more are involved in other areas of their lives at this time. It is their thought, foresight and effort that has created the Society we have. We should be truly grateful because we need it all today. Our mission statement says, “The California Society of Anesthesiologists is a physician organization dedicated to promoting the highest standards of the profession of anesthesiology, to fostering excellence through continuing medical education, and to serving as an advocate for anesthesiologists and their patients.” That is an open declaration to a commitment to the highest standards of patient care. That is exactly where I want to be. We do this through self-improvement and evolution with continuing medical education and by advocating for patients — and yes, ourselves, for when we advocate for ourselves, we advocate for our patients as well. We must define ourselves and not be defined by others. We share a rich history of accomplishment that was achieved by physician-led anesthesiology in improving patient care. And with this we must plan to move forward.

As I go through this next year — should I get your votes today, as I hope I do — I plan to focus on three main areas. First is public awareness: to explain to people what we have done for them, are doing for them and can do for them going forward, to increase their health and their well being. To make sure that the bright line differences remain drawn as our work continues. There are many ways to do this, one of which is to use the richness and diversity of our membership to engage others. We are truly fortunate. We have physicians in clinical care, research, academics, government, private practices, urban and rural areas, individual practice, care team and mixed models. This allows us to tell our story from a large number of different perspectives. It is a good opportunity at the right time to tell others what we have done and what we have to offer; to review the past and look forward to the future, so that we continue to improve patient care and patient safety.

Second is that we need to get legislative recognition, because in and of itself, PR is not enough. It is our job to make sure the legislators and regulators in Sacramento see the benefit that physician-anesthesiologists provide, and to make sure that our uniqueness is recognized in the shifting landscape of legislation and regulation. And this is the time to do it. In this legislative cycle there are almost 40 new elected legislators out of a total of 120. There are many people to bring up the learning curve. This is another area of great opportunity for us.

The third major area is that the CSA should help you do what you do better. Your dues provide the bulk of the income for our Society, and we need to make sure that you get as much value as you can out of those contributions. We do this through the Educational Programs Division with its evolving programs, formats and means of delivery. We do this through the Legislative Division of LPAD, working to allow Anesthesiologist Assistants to practice in California, explaining our perspectives in Sacramento and dealing with the many bills in the Legislature, and also, through the Practice Affairs Division of LPAD. When it’s late in the night, you have finished a full clinical day, you see everything that is coming your way, and you try to figure out where and how are you going to get the information to understand what is going on, come to the CSA website, check out the articles and the links. If we don’t have what your practice needs, tell us, email me and or contact the CSA office. I have talked with our Executive Director, Ms. Kahlfeldt, and we are going to start a new way to ensure that your ideas and suggestions are forwarded as promptly as possible to your Executive Committee. We will be focused on increasing the value of your membership. These are the major areas I intend to focus on in the next year.

If you are wondering what you can do to help with this, I have some suggestions there too. This is a team effort, and it is going to require all of us. Find a non-member and talk to them about joining. If they agree with us, that’s wonderful and they should be a member. If they don’t agree with us, that’s just as good — they should bring their reasoned arguments and be part of the discussion. Let us grow together. Contribute to GASPAC. When you get Legislative Alerts, respond to them — call your legislator, send them an email. When you are asked to participate in a letter writing campaign, take the time to write and ask somebody else to write. If we are not willing to speak up for ourselves, just who is it that we are expecting to speak for us? If you have a passion, find a committee that meets your needs and join it.

There are great opportunities for us ahead. There is much to do, and for your Board of Directors it’s going to start right after this meeting. It’s about our patients and our future. Let’s be a part of it. Thank you.

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