Co-authored by Robin Robbins, MD, and Rexford Pearce, MD.
This year, anesthesiologists from around the country arrived in our nation’s capital to attend the annual American Society of Anesthesiologists’ Legislative Conference. With generous support from the CSA, residents and fellows from California were able to attend. The conference provided the latest information about federal and state legislative, regulatory, and political issues affecting today’s practice of anesthesiology, and encouraged a nation of anesthesiologists to become leaders who will protect patient safety and the future of anesthesiology.
The conference included informative talks about combating the current opioid crisis, the next steps following the successful Safe VA Care initiative, and revisiting MACRA. There were also engaging sessions with US representatives on both sides of aisle – sharing their vision for the future of American health care. Other sessions included interactive public-speaking exercises with tips on how to conduct successful interviews and meetings with legislators. The conference culminated with a visit to the Capitol and meetings with representatives, senators, and staff.
It is an interesting time to be in Washington DC with uncertainty about the direction of healthcare reform and scope-of-practice issues. It is easy to become disillusioned and question if contributions, both monetary and time, make any difference in the current political gridlock. “How does the ASAPAC represent me?” is a common question we have been asked since returning home from the conference. The simplest answer is that being present makes a difference. Sitting on the sidelines has never made worthwhile contributions to our profession or been an impetus for change. But we realize people yearn for tangible results, so we will share this success story with you.
In 2013, the VA Office of Nursing Services proposed that advanced practice registered nurses — nurse practitioners, midwives, and nurse anesthetists – should have an expanded role at the VA, where they would be able to practice independently without physician guidance or supervision. Proponents claimed that increased autonomy for nurses would fix the problem of long waiting times for outpatients to see VA physicians. However, if implemented, the proposal would have abandoned physician-led, team-based VA anesthesia care and replaced it with a nurse-only model of care.
The ASA studied this issue extensively and found no documentation of delayed VA surgical care due to any shortage of physician anesthesiologists. They advocated strongly for preserving the quality of care for all veterans, leading to a record number of comments in support of preserving physician-led anesthesia care. In the final rule, nurse anesthetists were excluded from independent practice at the VA.
We appreciate the bipartisan group of congressional representatives and senators that upheld the importance of our specialty. Expertise matters; your involvement matters. Our continued success, as the ASA official seal suggests, requires vigilance. A new bill, HR 1783, includes the troubling “independent” practice provision that is not in line with the VA's final rule, putting veterans’ health and safety at risk.
The ASA Legislative Conference was a highly unique experience for residents. It exposed us to the crucial aspects of medical practice pertaining to policy, patient access to care, and the economics of medicine, which are frequently overlooked during residency training. As residents, we often develop relationships with our patients and see their struggles to navigate the health care system and gain access to care, thus providing us with a unique perspective into the issues patients face and the impacts of potential legislation on our patients. At the same time, we as residents want to preserve a fair and equitable future in our profession after years of hard work and sacrifice.
The ASA Legislative Conference provided an outstanding opportunity to speak with members of Congress and legislative staff about how policy changes can benefit patients as well as young people who aspire to a fulfilling career in medicine. This conference was especially inspiring to young physicians, who were reminded that there is much to be done and to fight for even beyond our training — that our endless hours of training are for a larger common goal of patient safety and quality care.
Residents were welcomed with open arms, and the mentorship was priceless. We were educated and showered with stories to bring back to our own programs. By initiating a dialogue with policymakers early in our careers and beginning to understand the complex political system which governs our practice, residents gained the experience to become stronger advocates for medicine and the anesthesiology specialty in the future. Attending and resident physicians left feeling energized and ready to do more.
There is much work to be done. Here’s how you can help: