Central Line
Episode Number: 142
Episode Title: Inside the Monitor: Advocacy
Recorded: September 2024
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VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. KEYA LOCKE:
Hello and welcome to
Central Line. I'm Dr. Keya Locke. Your host, Dr. Sam Page is with me today. Dr.
Page is our guest editor of the October ASA Monitor, which delves into the
topic of advocacy. He's so graciously going to share his expertise with us
today, so I'm pleased to welcome him back to the show. Dr. Page, you've been a
guest on Central Line in the past, but can you give our listeners a quick
reminder of your advocacy related experience and roles?
DR. SAM PAGE:
Yes, and thanks for
letting me join you today. I've been involved in advocacy really since
residency. Currently, I'm chair of the ASA Committee on Governmental Affairs,
which I've done for the past five years. I've been on this committee off and on
for about 20 and I've held several elected positions back in Missouri. I'm
currently Saint Louis County Executive and I’ve served in the state legislature
and on the city council in my suburb. So I've had a
lot of opportunities to interact with elected officials.
DR. LOCKE:
Excellent. I want to
start today by inviting you to share your thoughts on what is possible. Sometimes
it feels like protecting patient safety, defending the specialty are really lofty goals, and it's hard to visualize as
individuals what we can do to make a difference, which of course is what
advocacy is all about. So why would you say it's important for
anesthesiologists to get involved in politics and advocacy efforts?
DR. PAGE:
Well, you don't have to
spend a lot of time in the operating room to start to see how decisions made by
others in state or federal government impact our ability to take care of our
patients. Um, everything from drug shortages to regulatory issues around IV
access to reimbursement for, you know, taking care of our patients and being
able to provide them the services that they need. So just about everything we
do in medicine these days is regulated, and it's very important that we're in
the conversation about what the right decisions are so that we can take good
care of our patients.
DR. LOCKE:
Yes, I definitely agree. I mean, it's important. And I'm sure you
would agree that for us to understand that we can still make a big impact, as
you said, with minimal, I guess, time investment, doesn’t take that much time
to still be involved. Um, so thank you for sharing that and more. Globally
speaking, what would you say is at stake here? What are the key issues the
anesthesiology community is advocating for? And if you could talk about threats
and opportunities that are coming our way.
DR. PAGE:
Well, the opportunities
really surround engagement in the entire surgical experience, preparation for
surgery and post-operative recovery. The opportunity for us to engage in
decisions around testing and treatment post-operatively and in the recovery
period, to engage in, um, tightening up best practices in the operating room
decisions we're making. All of these can lead to a better quality of care. It
can lead to lowering costs, which increases the value of our services and
impacts the questions around reimbursement and and
the quality of care patients receive. That's a
conversation we should be in as anesthesiologists. And there's a lot of
opportunities every day developing around that question: access to new data and
new discoveries that that come out of our academic institutions every day.
The threats are really around patient safety, around surprise billing. Our
patients for a long time were dealing with bills that they did not expect. It's
really a question of surprise lack of insurance coverage for what they thought
was a routine experience. We've navigated that with federal legislation, but
unfortunately, the implementation of that legislation through government
regulations has been broken, and we're working to change that to make it more
fair to the patients and to the doctors taking care of them.
We're also very worried
about the quality of care in VA hospitals. And there are proposals now in front
of the Veterans Administration to remove anesthesiologists from the anesthesia
team in VA hospitals as standard of care that you wouldn't find in any of the
major health systems or hospitals across the country that take care of
complicated cases on a regular basis. And we know that our veterans can
sometimes very, very sick and complicated patients. There's lots of issues at
the state level that come up in the state legislature, issues around title, who
can call themselves a doctor or an anesthesiologist or a resident, and the
confusion that causes in a patient care setting, the confusion it causes in the
operating room and the intensive care unit. We think it's very important for
patients to know the education and training of the people taking care of them,
and we think it's important that an anesthesiologist is involved in every
anesthetic, and there are lots of state and federal issues around that.
DR. LOCKE:
Um, I know even when I
was still a resident, there was talk and there
conversation about scope of practice and things that you've just spoken about.
Would you say that that's an ongoing battle? It seems like. Would you say that
that's something that we will continue to have to battle into the future, or
any thoughts on where we are with that in general?
DR. PAGE:
Well, I don't think that
ever goes away. Every specialty of medicine faces questions around what's the
role of a doctor on the patient care team? What's the role of other providers
who play a very important part of taking care of our patients. Physician
assistants and nurse practitioners and registered nurses and patient care
assistants and technicians. They all have important roles in the hospital and
in the operating room. But we know that the team needs to be led by a physician
anesthesiologist, and we want to make sure that that standard is applied
everywhere in the country and in every anesthetic. And that's a conversation
that I think is going to continue as we struggle with more people who need
surgery, less providers of anesthesia services available. That's the question
is, and that pressure is always going to be there.
DR. LOCKE:
Yeah. Thank you for
that. It sounds like, you know, it's an ongoing involvement on our part that's
going to be needed even for the next group of folks coming up, even after me. So what would you say success looks like? You know, with all of our efforts. Can you talk a little bit about the
results of ASA's advocacy efforts, both on the federal and state level.
DR. PAGE:
Well, I think success
looks like holding our standard of care in the veterans
hospitals to make sure that all of our veterans have access to a physician
anesthesiologist when they need surgical care. Success would be repairing the
surprise billing legislation that is broken in its regulatory application. We
probably will need to be new legislation to fix that. Success would be allowing
anesthesiologists to practice at critical access hospitals in in rural America.
As it stands today, anesthesiologists are locked out by a unique quirk in the
reimbursement models for these hospitals in rural areas that don't have a lot
of volume in their case mix, and that we're working very hard to address that
issue. Something that we've identified as a priority, because AAs are important
part of the anesthesia care team and work under the medical direction of an
anesthesiologist and health centers all over the United States, and certainly
are involved in even the most complex cases in just about every type of
anesthetic.
We had a couple of big
wins in the past year in Utah and again in Nevada, where licensing was passed
and advanced in a way that allows anesthesiologist assistants to expand their
practice in these states. And that's important for the folks who have been working
on that a long time there. There are anesthesiologist assistants who were born
and raised in Utah and Nevada, but haven't been able to work there, and will
now be able to go home and practice in the place where they grew up near their
families. And that brings a new type of anesthesia provider to the state and
helps take care of some of the workforce shortage issues that they're facing.
And in Utah, for example, I know they worked on that bill for ten years, and
that was an ongoing conversation. It took a long time to get that through the
legislature. A lot of advocacy efforts by the anesthesiologist in Utah and by
their state component society. And it doesn't always take ten years, but it
almost always takes a long time. It's rare that you can have a bill sponsored
and have it pass in one legislative session, and that's why the continuous
advocacy is so important.
There are independent
practice bills in 15 or 20 states every year, and some states have had a CRNA
independent practice bill every year for 20 years. And the anesthesiologists in
those states work hard to explain the difference in education and training of
anesthesiologists and nurse anesthetists, and they work hard to make sure that
the elected officials making these decisions in licensing understand the
importance of having an anesthesiologist lead the anesthesia care team.
I think from the bigger
picture, success is embedding advocacy, education, and the expectation of
advocacy in the practice of every anesthesiologist in residency. We're doing
that now. We have an Advocacy Champion program that Dr. Tony Conte from
California has developed. And there's more information available on the ASA
website. Participating in the in the legislative conference in May--we'll talk
more about that later.--that's important. But I think
we have all of these things we have to do on these
individual goals and issues that we're working on. But really, success is every
anesthesiologist knowing their elected officials, being comfortable with
spending a little bit of their time communicating policy questions, and then a
subset of active anesthesiologists will take it even farther than that. They'll
run for office. They will participate in the legislative conference. They'll
have greater participation. But success isn't just the issue of the day. It's
also embedding advocacy in our scope of practice and our expectation of a
practicing anesthesiologist.
DR. LOCKE:
Thank you so much for
that. I mean, from what I've come to understand about advocacy is that it is
certainly a marathon rather than, you know, sort of a sprint. So what advice would you give to our listeners who are
looking to get more involved, but may just be overwhelmed with trying to find a
good starting place? Specifically, when you talk about getting involved in
politics or supporting certain candidates, or even, as you mentioned earlier,
becoming candidates themselves, could you paint a picture for us of what some
of the possibilities are and how we can go about engaging more effectively,
even with our local community?
DR. PAGE:
Well, there are lots of
ways to engage the political process. The initial opportunity would be to
respond to an ASA alert to communicate with your elected officials about a
particular issue, to send an email or call your member of Congress or your
state legislator. A more, more advanced opportunity would be to just have a
meeting, call up these folks and say, you want to have a meeting with an
elected official or a member of their staff to talk about an issue that's
important to you, and they will meet with you. They will meet with physicians
from their district, or a member of their staff will whenever asked. It's a good experience to understand how to
communicate with elected officials. And they they
certainly want to hear from you. It's easier to communicate with an elected
official and get in to see them if they've met you before they were elected.
And that's why it's so important to pay attention to who's running for office,
to look at their websites, to talk to your your
peers, talk to our state and federal lobbyists, and find out who has a track
record of supporting issues that are important to us. Issues of patient safety
and the things that we've been talking about and get involved in those
campaigns. Go meet the candidate. Find one that you like, put out some yard
signs for them, and let them know that that you're supporting them because of
their record.
DR. LOCKE:
Thank you again for
that. And I think as you mentioned so eloquently, it's really
important to get involved early and to stay involved for the duration.
Um, we know that ASA has recently launched a new Resident Advocacy Champion
program. Can you talk about the role anesthesiology residents play in advocacy
and tell our listeners why it's so important to get involved?
DR. PAGE:
Well, part of the scope
of practice of anesthesiologists is to engage your elected officials. And if
that's not something that you're comfortable with yourself, then you'll want to
appreciate your colleagues who are doing that and make
arrangements for them to have a flexible schedule so they can do that.
And it's important to get involved as a resident as you're starting to learn
the nuances of anesthesiology. It becomes obvious pretty
quickly where state and federal regulation and law will impact your ability
to take care of your patients. And you're really well
positioned to have these conversations with elected officials and their staff.
And they're certainly interested in hearing from young physicians who are
starting out in practice, who are going to be practicing in their community for
30 years. They want to know what's important to you. And making that investment
in time early in your career makes it a lot less frustrating to try and
navigate the practice of anesthesiology. If you have the tools to engage your
elected officials and impact the decisions that they're making.
DR. LOCKE:
Thank you so much. I'll
just add that, you know, resident involvement, especially when they kind of get
your boots wet, as you mentioned early, just really helps build those
relationships again early on and get you really comfortable
because it can be uncomfortable talking to politicians. I know I kind of got
involved in the legislative conference as CA3. And, you know, you may even find
for our people who are just starting out, that you're quiet for most of those
meetings. But I think just getting your boots wet and feet on the ground and in
the practice of engaging really early just helps
ensure that you'll stay engaged throughout the course of your career. And I
know you're going to talk to us a little bit about the legislative conference,
which was recently held. And for our listeners who haven't attended this
conference, can you tell us why it's important and what happens in DC during
those really sort of action-packed days?
DR. PAGE:
Well, the ASA
Legislative Conference is really one of the biggest anesthesiology meetings of
the year. It's held in Washington, DC every May, Monday through Wednesday, and
we spend the first day and a half getting an update on the key issues that are
before Congress at that particular year. And we hear from members of Congress
and members of the administration who hold key leadership positions. We hear
from them about the issues, their perspective, and what they see and what
direction they think things are going. It's a great way to be caught up on
what's happening. It's a great way to hear it directly from the decision
makers. And then once armed with this information, we schedule, um, visits with
our members of Congress and their staff. Tuesday and Wednesday, we get around
to see our elected officials and we tell them our concerns. We relay personal
stories about how these decisions that they're making impact our ability to
care for our patients and the health of their community. It's really a very
rewarding experience to be armed with the information, to allow you to
communicate effectively with members of Congress, and we really do change the
decisions that are being made by being present and being in that conversation.
And it really makes it much more effective for our lobbyists to follow up and
visit with our elected officials after they've heard from someone in their
district, a real physician who is taking care of of
their constituents. It's a very rewarding experience that we always get high
marks from the attendees, and it's always a really good
crowd.
DR. LOCKE:
Yes, as you mentioned,
it is one of the largest meetings that ASA holds, but it's it's
for our listeners. It's not as big as the ASA meeting. So
I think for residents and younger faculty kind of just getting involved in the
advocacy process, it's a great place to sort of start and get your feet wet.
Would you agree with that Dr. Page?
DR. PAGE:
Yeah. It's a it's a
good experience as a resident or a young physician to visit with a member of
Congress, with someone, an anesthesiologist who's got a little bit more
experience, who's had these conversations over the years. Um, it's like taking
care of a patient in the operating room. You know, you see a few cases before
you're out on your own, uh, doing this with some supervision and guidance. And
the first time you go see an elected official, you're going to be with somebody
who's done this before and knows how to get their point across, and you'll be
watching and learning.
DR. LOCKE:
Wonderful. So what can you share with us about the October issue of The
Monitor? And sort of what do you hope our readers will take away from that? And
is there anything specific in the issue that you took away from editing?
DR. PAGE:
Well, there's a recap of
the ASA legislative conference in May, so we'll talk about some of the
highlights of who was there, who spoke to us and what we learned. And then
there are articles that identify some of the key advocacy activities over the
past year. Dr. Mike Beck from Utah will talk about his success in the AA
licensing bill, the importance of relationships with elected officials, the
title misappropriation bill that moved through Utah and the advocacy work of
anesthesiologists to get that bill passed. Dr. Alex Choi and I have an article
about running for office. Um, if you are thinking about running for office, we
have some pointers, but more importantly, offers some ability to follow up.
We've developed a work group to mentor candidates for office and anesthesiologists
who are thinking about sometime becoming a candidate for office. We want you to
be successful, and we have a bipartisan support to help you do that. Uh, John
Scott has an interesting article there about how to hold a fundraiser in in
your home to help an elected official. Having a fundraiser in your home is a
great way to help someone who agrees with you be successful in their campaign.
It's a great way to build relationships with decision makers. And Dr. Tony
Conte has an article there about his Resident Advocacy Champion program, and
it's a really cool program that recognizes residents
who research an issue, become familiar with it, and then meet with an elected
official and then report back from that meeting. It's a great way to get
started in learning how to communicate with decision makers at a very early
point in your career.
DR. LOCKE:
Thank you so much, Dr.
Page, for your time and expertise. I think this has been a great conversation.
And to our listeners, thanks so much for tuning in and for your likes, shares
and feedback. You can always learn more about this topic at asamonitor.org, and
please join us for more Central Line soon.
DR. PAGE:
Thank you. Thanks for
having me on.
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