TSA Bulletin - July 2012

What does it mean to be an “anesthesiologist”? In common usage, obviously, it means many things to many people, but looking at the origin of the word, it clearly means a person who engages in the science of anesthesia. Most of us are busy putting that science to use for the benefit of our patients. And some of us produce that science. It is that science that sets us apart from those trained to only use the techniques of anesthesia. And those techniques become ever more refined as a result of ongoing scientific endeavor. Studying the principles of science allows us to critically evaluate research and translate it to clinical care. Yet, we don’t have enough scientists. If we want to remain in the forefront of patient safety, we need ongoing research and researchers.

This year, the Texas Society of Anesthesiologists is making a step in the right direction. For the first time, we will have a juried research paper presentation at our Annual Meeting. The TSA Education Sub-Committee on Research, chaired by Dr. Evan G. Pivalizza has invested a lot of time to develop this. Please make an effort to view the presentations and freely express your opinion to our junior researchers. Furthering and encouraging researchers hopefully will lead to more research; and we need that desperately.

You may also want to consider donating to TSA’s research fund. Just send a check to the TSA office. It will be put to good use.

Reading the above paragraphs, some may think, what I do is as much art as it is science. Right on! We need to have compassionate personal interaction and manual skills to put science to use. This understanding of our work as art does not end in the operating room; some of us take it home and create art in all disciplines. Let’s share that! Again, for the first time, the Texas Society of Anesthesiologists will have an art exhibit, showing the wide spectrum of artistic talent that we have in our community. The exhibit was organized by the TSA Art Committee, chaired by Dr. James K. Sims. Please submit your work of art and allow your colleagues to enjoy it.

Isn’t it wonderful that we have the freedom to create art and that we can freely practice the art of our craft? We owe that, of course, to the rights that we grant each other by accepting and honoring the constitution, and we owe it to those who put their lives on the line to defend that freedom, our military colleagues. The Texas Society of Anesthesiologists has made it a priority to help our military anesthesiologists and their families. Already, we have heard how hard life can be for the family when an anesthesiologist, or the spouse of an anesthesiologist, gets deployed overseas. To provide a little help, the TSA has decided to suspend the dues of such members. We need to do more. Please identify military anesthesiologists in Texas to the TSA, and encourage these members to wear their uniform when they attend the TSA Annual Meeting. By them doing so, we may all express our thanks.

It is also great to hear time and time again that we have achieved the 6-sigma level of quality as the only specialty in medicine. Is that reason for us to rest on our laurels? No! Much remains to be done. Expanding our efforts to the continuum of patient care in surgery has the potential of saving thousands of lives, reducing morbidity, and in so doing saving “Billions of Dollars.” I am not kidding! I mean “Billions” with a “B.” There is ample evidence for this coming from projects in Michigan and Tennessee, just to name a few. To put such methods in action the Texas Society of Anesthesiologists has founded and incorporated the Texas Surgical Quality Collaborative. Dr. David C. Mackey and his committee are spearheading this initiative and following our Annual Meeting in September there will be a conference in Austin that will initiate this effort. It is our goal to design a system wherein the fruits of these cost saving efforts will actually go back to those who work for them: Texas anesthesiologists. Please attend the TSA Annual Meeting to learn more about this most promising project.

Talking about money reminds me of another milestone in the history of the TSA: Earlier this year, we had the first Texas Conference on Practice Management. Dr. Jackie Ralston and his committee organized that meeting, and it was a resounding success. Although national resources exist, for example those provided by the ASA, there are many Texas specific practice problems that can only be addressed by a Texas specific conference. Anesthesiologists in Texas will only be able to survive if their practices are financially sound. For that, they need the best practice management advice that they can get. The TSA Practice Management Conference strives to provide that.

As many of you know, I live in Dallas, but as I am writing this, I am at the TSA office in Austin. Today, for the second time, Dr. Thomas J. Oliverson and I testified before the Texas Medical Board as they are struggling with the existing rules for “Office Based Anesthesia” (OBA). The OBA Rules have been in place for many years and are now showing their age. Dr. Oliverson and his committee have cumulatively spent hundreds of hours discussing the various ambiguities and loopholes in the current rules. As a result of this tedious work, the TSA has sent a multipage comment to the Texas Medical Board. Our overriding concern is the safety of patients in Texas, wherever they may receive their surgery and anesthesia. We advocate for the same quality and safety in offices as exists in accredited facilities, and for that we have made a great many specific suggestions.

Only four days prior, I was testifying in the same building in Austin, that time at a hearing of the Texas Department of Insurance (TDI). Although last year the Texas medical community had reached an agreement with the Texas Commissioner of Insurance about rules pertaining to PPO networks, upon the appointment of a new Commissioner, those rules were suspended. Now new rules have been proposed. Those new rules would be very damaging to anesthesiologists as, in essence, they would allow insurance plans to dictate the rates they want to pay us. Guess where that would end up? Drs. Joe E. Monk and David E. Bryant and their respective committees have done yeoman’s work in preparing our comments to TDI and both stood up and testified on your behalf.

Not too long before that issue had come up, the three of us had already been to Austin several times testifying on another set of rules. These other rules were those which would implement Senate Bill 7 (SB7), the bill that creates health care collaboratives (HCCs). SB 7 had strong input from our very own Representative John M. Zerwas, M.D., ASA President-Elect. The intent of Dr. Zerwas’ bill writing was to assure that hospital based physicians had adequate input into the governance of such HCCs. Again, the respective committees of Drs. Monk and Bryant have spent hundreds of hours sifting through the proposed rules and fashioning our responses. We are anxiously awaiting the final rulings.

You may wonder: “Is all that new?” The answer is simply “no”. The Texas Society of Anesthesiologists is now in its 76th year. Many hurdles had to be overcome to arrive where we are today. What were the challenges in the past? Can we learn from them? To answer these questions Drs. Udaya B. Padakandla and Charles C. Tandy, with the TSA History Committee, have begun videotaping the surviving Past-Presidents of our Society to assemble a lasting documentation of the trials and tribulations that have stood in our way. This survey will showcase the successful ways that these presidents and their committees used to overcome them. Please attend the inaugural viewing of these videos at our Annual Meeting in September.

As you can see, much is happening, and I could report about many more activities, all done by unpaid labor, the volunteer committee members that serve you. Yet, much more could be done. Think about this: as your President I have had the privilege of visiting with many politicians, some of them high ranking. One of them came to me recently asking for financial support for his campaign. I had explained to him that we have over 3000 members. He said that was wonderful, and why did I not get all 3000 to donate $1000 each, that would yield $3 million, more than enough to finance his campaign. This politician was a Republican. He pointed out that if Obama stayed in office, every anesthesiologist may have to pay $40,000 more in taxes, thus $1000 seems to be a good investment. There is truth to this. Imagine if we all gave $1000 to our PAC. We would be very powerful. Imagine we would all invest just one hour per week to work for the common goal. That would yield 156,000 volunteer hours per year. We could move mountains. We need self starters, people that take on a challenge and then produce a result. I am very encouraged to see a good number of junior anesthesiologists go through the leadership college of the TMA. Drs. Gerald Ray Callas, Crystal C. Wright and Charles E. Cowles have done it. They are the shining future of our Society, and many more anesthesiologists, some fresh out of residency, are lining up for this training or other qualifying activities. We now have an ad-hoc committee in place that will help aspiring anesthesiologists gain access to leadership roles in medicine and society at large.

Dark clouds may loom on the horizon but our future is bright, and will get brighter yet with each and every one of you contributing just a little.

See you in San Antonio.