VOLUME 31, ISSUE 1

The American Society of Anesthesiologists (ASA) Policy Research Rotation in Political Affairs, offered to five selected anesthesiology residents annually, provided a September I won’t soon forget. During my rotation, I obtained insight into the inner workings of our national society, met with federal legislators, attended the judicial hearing of our recently confirmed Supreme Court Justice Brett Kavanaugh, and so much more. It proved to be a very exciting time in Washington D.C. with the last push to complete legislative work prior to midterm elections, the end of the ASA Political Action Committee (PAC) fiscal year and multiple legislative policy meetings on Capitol Hill. I worked directly with our society’s Advocacy Division in D.C. and learned, firsthand, the political, legislative, and regulatory factors that impact our delivery of patient care.

The ASA Congressional and Political Affairs Department is located in the ASA’s Washington, D.C. office. What happens in Washington D.C. directly impacts anesthesiology and the patient care that we deliver, from the payment for anesthesia services to the regulatory and legal environments that affect how anesthesiologists can practice. Unlike virtually any other industry, the government is deeply intertwined with health care, and thus anesthesiology. The goal of the Congressional & Political Affairs Department is to advance the interests of anesthesiologists and the ASA through the legislative, regulatory, and political pillars of advocacy. Advocacy is a political process by an individual or group which aims to influence public policy and resource allocation decisions within political, economic, and social systems and institutions. The goal of the ASA advocacy work is to ensure that, when Congress or the Executive Branch does something, the ASA has a seat at the table.

As physician anesthesiologists, the promotion of patient safety is not limited to our clinical work. We are the leaders in patient safety, and advocacy is an essential component of our profession. There are multiple levels of advocacy and ways you can advocate for your patients. These range from daily direct patient clinical interactions, providing insight to hospital committees at the systems level, or being active within your professional society at a policy level. Our advocacy impacts all aspects of our practice and we have a professional duty to stay involved. Our professional citizenship is defined as a willingness to accept the responsibility and ownership, not only for the present state of our specialty, but the future state as well.

My role in advocacy for our specialty began during my intern year at Texas A&M/Baylor Scott & White. I was fortunate to have a faculty member, Dr. David Gloyna, host Ms. Bonnie Bruce, the Texas Society of Anesthesiologists Governmental Affairs Director. During this evening, I was shocked to learn of Ms. Bruce’s encounters with organizations trying to belittle our profession and hinder patient safety. This experienced sparked my interest and I sought out opportunities to get involved in the advocacy process.

The ASA advocacy division is currently fighting many federal level attacks on our specialty. The Congressional and Political Affairs department focuses on many issues, including scope of practice, the national opioid epidemic, and ongoing drug shortages, just to name a few. The ASA payment and practice management division works hard with the Centers for Medicare and Medicaid Services to ensure anesthesiologists receive appropriate reimbursement.

When imagining my first day as an ASA Resident Scholar, I thought the day would be slow; perhaps I could study or complete a research manuscript, etc. However, I quickly realized that this would not be the case. As I was introduced to the staff members at the Washington, D.C. office, I learned that they were ready and waiting for my arrival. After taking some social media introductory photos, I accepted the tasks at hand. Tasks which included weekly ASA lobby calls, attending re-election fundraising events, drafting solicitations for the ASAPAC, assisting with ASAPAC donation awards, drafting the ASA Washington Alerts, and my personal favorite job, meeting with several Capitol Hill legislators.

It was an honor to work alongside Manny Bonilla, Chief Advocacy Officer, and Nora Matus, Director of Congressional and Political Affairs. Manny and Nora are both highly regarded on Capitol Hill and represent us well. We are lucky to have them! Nonetheless, it is a rarity to have a physician at these discussions. I was surprised by how engaged and eager our legislators were to hear my perspective of the issues. During these meetings, I helped clarify the mechanism of peripheral nerve blocks, the burden of prior authorization by insurance companies, and the negative impact of drug shortages on patient care. These discussions are the stepping stones of future legislation that improves the care for our patients and longevity of our specialty.

During my month, I was able to experience how prior advocacy exerts its positive effect. In May 2017, I attended the ASA Legislative Conference where our “Hill Day asks” included increasing drug take-back and disposal programs and educating lawmakers on the importance of multi-modal analgesia. This later translated into legislation in the form of House Bill 6, the recently signed opioid package law, including those provisions we had discussed back in 2017.

There are few experiences that provide a life-long impact, but this rotation offers just that. The benefits are immeasurable: growth in public speaking skills, enhanced professionalism, and exposure to real-world political processes. This rotation has intensified my passion for patient safety and advocacy for physician anesthesiologists. In today’s medical environment, it is not enough for physician anesthesiologists to only be engaged clinically. We must also be active members in shaping politics by facilitating our elected officials’ ability to make policy in an educated manner. The knowledge and skills of physician anesthesiologists can be life-saving when seconds count. It should be our goal to ensure that the role of the physician anesthesiologist will not be diminished in the future.