The Future of Anesthesiology for medical students who may be - PowerPoint PPT Presentation

The Future of Anesthesiology for medical students who may be interested in participating Kenneth Y. Pauker, M.D. Discovering Anesthesia Subspecialties 2012 Inaugural California Anesthesia Medical Student Symposium UC Irvine School of Medicine Irvine, CA Saturday, September 22, 2012 Saturday, September 22, 12

No Conflicts of Interest to Disclose Saturday, September 22, 12

Kenneth Y. Pauker, M.D. California Society of Anesthesiologists Immediate Past-President Associate Editor, CSA Bulletin Former Chair, Division of Legislative and Practice Affairs American Society of Anesthesiologists House of Delegates Committee on Performance and Outcomes Measurement Committee on Communications Committee on Credentials Formerly, Committee on Governmental Affairs and Committee on Anesthesiologist Assistant Education and Practice University of California, Irvine, School of Medicine Assistant Clinical Professor (Volunteer) Department of Anesthesiology and Perioperative Care Saturday, September 22, 12

What is the basis for the anticipated radical changes in American Medicine? Demographics — aging boomers Healthcare costs: • US is #1 % GDP (2009) — 17.3% of and rising • US is #1 per capita — $7,960 • #2 per capita is Norway — $5,352 (9.6% GDP, #16) • #2 % GDP is Netherlands — 12% ($4914, #4) • Europe generally 11-12% GDP Saturday, September 22, 12

What is the basis for the anticipated radical changes in American Medicine? Demographics — aging boomers Healthcare costs: • US is #1 % GDP (2009) — 17.3% of and rising • US is #1 per capita — $7,960 • #2 per capita is Norway — $5,352 (9.6% GDP, #16) • #2 % GDP is Netherlands — 12% ($4914, #4) • Europe generally 11-12% GDP Federal, state, and local government payments for US healthcare = 45% of total $2.6 trillion (2010) Federal share = 29% (cf. 23% in 2007) Saturday, September 22, 12

"Get ¡your ¡facts ¡.irst, ¡and ¡then ¡you ¡can ¡distort ¡them ¡as ¡much ¡as ¡you ¡please." Saturday, September 22, 12

Under the Hood of Socio-Politico-Economic Influences • Supply produces demand with incentives to do more • Inertia to render non-beneficial care • Hidden medical liability influences Saturday, September 22, 12

Bending the cost curve Institute of Medicine (IOM) Report (2000) results in demand for safety and cost-effectiveness: Saturday, September 22, 12

Bending the cost curve Institute of Medicine (IOM) Report (2000) results in demand for safety and cost-effectiveness: • The promulgation of Pay for Performance (P4P) Saturday, September 22, 12

Bending the cost curve Institute of Medicine (IOM) Report (2000) results in demand for safety and cost-effectiveness: • The promulgation of Pay for Performance (P4P) • The advent of the new science of performance measurement Saturday, September 22, 12

Bending the cost curve Institute of Medicine (IOM) Report (2000) results in demand for safety and cost-effectiveness: • The promulgation of Pay for Performance (P4P) • The advent of the new science of performance measurement • Now Value Based Purchasing (VBP) and Accountable Care Organizations (ACOs) Saturday, September 22, 12

What is constant in Medicine? Saturday, September 22, 12

What is constant in Medicine? • The evolution of the Art and Science of Medicine Saturday, September 22, 12

What is constant in Medicine? • The evolution of the Art and Science of Medicine • The altruistic idealism of medical students Saturday, September 22, 12

What is constant in Medicine? • The evolution of the Art and Science of Medicine • The altruistic idealism of medical students • The imperatives for individual professionalism Saturday, September 22, 12

What is constant in Medicine? • The evolution of the Art and Science of Medicine • The altruistic idealism of medical students • The imperatives for individual professionalism • The necessity for engagement with professional organizations like the CSA and ASA and OCMA and CMA (?AMA or something else) Saturday, September 22, 12

What is constant in Medicine? • The evolution of the Art and Science of Medicine • The altruistic idealism of medical students • The imperatives for individual professionalism • The necessity for engagement with professional organizations like the CSA and ASA and OCMA and CMA (?AMA or something else) • Medical politics – local, state, and national Saturday, September 22, 12

“There ¡is ¡no ¡distinctly ¡native ¡American ¡criminal ¡class ¡except ¡Congress.” Saturday, September 22, 12

What is constant in Anesthesiology? Our commitment • to the critically ill and those with acute/chronic pain • to improve patient care and safety Saturday, September 22, 12

What is constant in Anesthesiology? Our commitment • to the critically ill and those with acute/chronic pain • to improve patient care and safety The tension between • what is comfortable v. what is unknown • minimizing risk v. pushing forward for ?reward • academic v. community perspectives Saturday, September 22, 12

Who was Emery A. Rovenstine? 1895-1960 1935 — Chair of Anesthesiology, Bellevue Hospital 1937 — 2nd American Professor of Anesthesiology, NYU School of Medicine 1943-1944 — President, American Society of Anesthetists (precursor of ASA) 1948 — a founder of ASA 1957 — ASA Distinguished Service Award 1962 — Inaugural Emery A. Rovenstine Memorial Lecture at ASA Annual Meeting Saturday, September 22, 12

How to synthesize this into predictions? • David Longnecker, 1996 Rovenstine Navigation in Uncharted Waters: Is Anesthesiology on Course for the 21st Century? • Mark Warner, 2005 Rovenstine Who Better than Anesthesiologists? • Ron Miller ‣ TF Future Paradigms, 2005 ‣ Rovenstine, 2008 The Pursuit of Excellence • Patricia Kapur ‣ CSA Bulletin, Summer 2008 ‣ Rovenstine, 2011 Leading into the Future Saturday, September 22, 12

“Dif.icult ¡to ¡see, ¡always ¡in ¡motion ¡the ¡Future ¡is...” Saturday, September 22, 12

References Kohn LT, Corrigan JM, Donaldson MS, editors: To Err Is Human: Building a Safer Health System. Washington, D.C., National Academy Press; 2000 Longnecker DE: Navigation in uncharted waters. Is anesthesiology on course for the 21st century? The 35th Annual Rovenstine Lecture. Anesthesiology 1997; 86:736–42 Miller RD: Report of the Task Force on Future Paradigms of Anesthetic Practice. ASA Newsletter 2005; 69(10, October):20-23 Warner, MA: Who Better than Anesthesiologists? The 44th Annual Rovenstine Lecture. Anesthesiology 2006; 104:1094–101 Kapur PA: The Future Practice of Anesthesiology. CSA Bulletin 2008; (Summer):30-35 Miller, RD: The Pursuit of Excellence: The 47th Annual Rovenstine Lecture. Anesthesiology 2009; 110 (4, April):714-720 Kapur, PA: Leading Into the Future: The 50th Annual Rovenstine Lecture. Anesthesiology 2012; 116(4, April):758-767 Saturday, September 22, 12

Longnecker’s Rovenstine 1996 • Cost containment imperative • Population-based care prioritized above individual care • Moving to ambulatory and home care instead of inpatient hospital care • Self-employed physicians searching for stable employment situations • Non-physician practitioners given more duties wherever possible Saturday, September 22, 12

Longnecker’s Rovenstine 1996 • Cost containment imperative • Population-based care prioritized above individual care • Moving to ambulatory and home care instead of inpatient hospital care • Self-employed physicians searching for stable employment situations • Non-physician practitioners given more duties wherever possible “...form alliances with surgeons and surgical organizations... ...emphasize perioperative medicine skills … on rotations where partnerships have been formed with surgical colleagues for the overall care of surgical patients... where the CA-3 resident would be “involved in the [entire] continuum of preoperative, intraoperative, and postoperative care of surgical patients...” Saturday, September 22, 12

Miller’s Predictions Ron Miller — TF Future Paradigms, 2005 ‣ Demographics, innovations, & economics Increased critical care, IT with databases and quality/quantity, robotics and voice activation, technical work by care extenders, credentialing based on demonstrated competence rather than training or boards, turf wars, scope of practice, medical procedures instead of surgery, genetic molecular medicine, imaging, drugs based upon pharmacogenomics How qualified to be intra-op practitioner, supervise how many ? technicians, role of anesthesiologist Emphasis on throughput and outcomes, systems analysis Opportunities — preop eval, prepare patients, critical care, pain management Saturday, September 22, 12

When you come to a fork in the road, take it. Saturday, September 22, 12