Obama Woos Doctors on Health Care Reform - Consider the VA

I think Dworkin in his WSJ opionion piece erred in how he tried to explain the sociologic changes that have happened to the medical profession over the last few decades. His analogies made it too easy to digress onto issues addressed everywhere else and ignore and important message that needs to be conveyed regarding my little understood specialty of Anesthesiology. People just don't know that their best friend in the operating room and labor suite is being accidentally "thrown under the bus" as part of the larger health care reform rush. A 60% income drop will be devastating to not only the profession but to patient safety well into the future.Anesthesiology is a difficult specialty for which to create quality practitioners. Merely having someone dedicated to caring about people is not enough. They also must be physically dexterous and mentally very quick. We use our experience as physicians to plot a course that minimizes risk and discomfort for each patient's medical condition. Our time frame for anticipating, preventing, recognizing and acting upon problems is in seconds. Even worse, critical situations occur suddenly out of nowhere. We work long hours at a task which requires continual diligence even if things seem routine. A mediocre practioner is fine when nothing is happening, but you cannot predict that things will remain routine. Judgement, skill and experience take a long time to develop. I would estimate it takes five or more years AFTER residency for a new anesthesiologist to see enough critical events to build a seasoned repertoire of responses. Before that, you're relying on training combined with the person being much brighter than average to keep you out of trouble. You cannot replace good anesthesiologists quickly and you cannot get good ones unless they are adequately paid relative to other specialities and professions.It wasn't long ago that anesthesiology was an undesirable "back water" specialty. It paid poorly and that meant you didn't attract the most capable graduates into the speciality. Medical students, choose a specialty that matches their personality and provides a good quality of life for their work. When incomes improved, there was an influx of the higher quality trainees. Those are the practitioners you enjoy today.The proposed degree of income reduction, perhaps 60%, would be devastating. Those talented individuals who invested an entire life of superlative educational effort and professional training would be asked to lose their homes, drastically curtail their children's education, and work harder for less pay. And as Dworkin alluded, physicians no longer enjoy a sense of being well valued in society. We get satisfaction for relieving pain, but in terms of return for effort we're essentially piece workers. Yes, you usually get paid by the case. How many people who are talented and bright would keep on delivering a superlative effort in a specialty that saw such an income cut, demanded more work, and further diminished their social standing? A medical student will give up 12 years of their life in preparing to become a novice physician. It isn't enough to just feel a "calling." There has to be sufficient recompense to make so onerous an initiation and life remain worthwhile to tomorrow's care givers. From the outside it may seem a "cushy" life, but it is not. Anesthesiologists face extreme stress every day. We work long hours. We work 24 hour shifts. We do it under the never ending pressure that it has to be perfect each and every time. There are no second chances. You'd be a complete fool to do it for just money. You'd burn out very quickly. A strong degree of dedication to excellence and patient care is also needed to sustain one through the anesthesiology career path. Cut reimbursements by 60% and most of your anesthesiologists, THE person dedicated to watching over you in the operating room, will lose their homes, be unable to send their kids through higher education, and have their life calling of helping others become a bitter lot in life. The best won't enter the field and you'll lose many already in it. In short, you shift the balance towards mediocrity. "Medical excellence every day" becomes "Medical ADEQUACY every day"I'm glad Dworkin spoke up. He raised a warning that needs to be addressed before patients get injured. Retirement of some of our most experienced anesthesiologists would be an early effect. Those in the middle of their careers will lose their homes and look hard at what other options they have. They are bright people and no degree of personal "calling" assuages a capriciously legislated inability to pay the mortgage and bills. Yes, anesthesiologists are better paid than the average person, but they work in a field that requires superlative personnel each and every time. Do YOU really want a cheapest person possible to keep you alive and whole? This is a terrible situation being brewed. Anesthesiology is a tiny specialty. It does not have enough numbers to wield the political clout to avoid being incidentally destroyed. We're potentially falling off a precipice that will hurt you the patient, demoralize today's practitioners, and cut off tomorrow's generation of anesthetic excellence. Dworkin does not get it all right, but I thank him for raising his hand. Anesthesiology and our patients need all the help we can get to help policy makers realize how bad this side effect will be.Guy Kuo, MD