Residents in a Room

Episode Number: 74

Episode Title: Physician Led Care

Recorded: March 2025

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VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

We all have that person that we look up to and emulate in residency to kind of go up to them and say like, hey, like, I really like how you've navigated this situation and kind of trying to emulate that.

These studies have shown that preventable deaths and adverse events are improved when a physician leads the anesthesia team, and that physician led care actually saves healthcare dollars by decreasing things like unnecessary consults and testing.

DR. COURTNEY BORG:

Welcome to Residents in a Room, the podcast for residents by residents. I'm Dr. Courtney Borg, a PGY2 at Mayo Clinic, Florida, and I'm here with Dr. Katelyn Williams to discuss a topic that many of us are invested in: physician led care. Dr. Williams helped pen an article recently for the February issue of the ASA Monitor about the topic. We're so excited to hear what she has to say. Thanks for joining me, Dr. Williams.

DR. KATELYN WILLIAMS:

Thank you so much for having me. I'm so excited to be a part of this podcast and speak to some of the residents out there.

DR. BORG:

Yeah, well, we're really excited to have you. Before we dig in, can you just briefly introduce yourself to our listeners, tell them a little bit about your pathway and a little bit about yourself?

DR. WILLIAMS:

Sure. Hello, everyone. First of all, thank you to the ASA Residents in the Room podcast and Dr. Borg for having me here today. So my name is Kate Williams. I'm an assistant professor and associate program director at the University of Louisville. I grew up just outside of Cincinnati, on the Kentucky side of the river, did my undergraduate degree at Vanderbilt in Nashville, and then I made my way back to Kentucky, to Louisville for medical school. And I've been here ever since. I really love our department here and enjoy working with the residents on a daily basis. I started getting involved with the ASA as a resident, and I've continued that work as an attending. Um, I enjoy my committee work and also getting the residents involved in advocacy and really love connecting with anesthesiologists from all over, and find it a really great way to give back to the ASA via committee work.

DR. BORG:

So, Dr. Williams, you were a co-author for one of the articles in the ASA Monitor. Could you summarize a little bit about what that article entailed and how it incorporated leadership training in anesthesia?

DR. WILLIAMS:

Sure. I'd be happy to. So our ASA committee, the ASA Committee on the Anesthesia Care Team, wanted to really look into leadership training and residency. So this article focuses on the importance of the anesthesia care team being physician led, and how we are training those physicians to be leaders of this anesthesia care team. We talk about the ACGME requirements for training of residents in leadership, and highlight some current program initiatives that are going on around the country in different anesthesiology residency programs. We also highlight some resources that are available from the ASA and then kind of pose a question of future directions. We, as a committee, would love to work on some additional resources to augment current education and optimize our residents’ ability to lead the anesthesia care team after graduating residency. And we've put that out there to the current residents, the new practice residents, and the program directors. So if you have received our survey, this is what we're trying to gauge. Do you want more of this programming? How can we best help you to help focus on this training? And so we'd love to get everyone's feedback and responses. And if anyone has more feedback, I would be happy to take that as well.

DR. BORG:

Great. So, um, let's talk a little bit about physician led care. Can you tell us what you know, physician led care entails, what model you think is best for our patients and kind of what's at stake going forward.

DR. WILLIAMS:

Absolutely. So this is obviously a hot button topic, uh, recently. And I think the model of physicians leading the anesthesia care team is safest and most efficient for our patients and our healthcare system. We have multiple other providers in the anesthesia care team, like nurse anesthetist and anesthesiology assistants, who play an extremely important role. But due to the nature of our training, I believe that anesthesiologist, the physician, is primed and going to lead this care team, uh, in the most effective way.

DR. BORG:

So, Dr. Williams, what are some of the studies tell us? Is there evidence that physician led anesthesia care is safer for our patients?

DR. WILLIAMS:

So there are multiple studies that have been done by independent agencies providing different care models of delivering anesthesia. Um, these studies have shown that preventable deaths and adverse events are improved when a physician leads the anesthesia team, and that physician led care actually saves healthcare dollars by decreasing things like unnecessary consults and testing. To get a little bit more specific with the numbers, there have been studies that have shown that the odds of an adverse outcome are 80% higher when anesthesia is provided without a physician leading the anesthesia care team. Um, and also that the presence of an anesthesiologist prevents 6.9 deaths in 1000 cases in which a complication occurred. And this was discovered during an independent analysis of nearly 200,000 Medicare patients who had orthopedic surgery. And furthermore, the odds of death were 8% higher, and the odds of preventable death due to a complication were 10% higher in patients whose anesthesia was not provided with an anesthesiologist as the leader of that care team. 13.

DR. BORG:

Well, those numbers are kind of staggering. They're they're pretty impressive all around. You know, as demand for anesthesia keeps growing. Um, you know, we see as residents that one day we're going to adopt this role as the supervising anesthesiologist. So what advice do you have for residents when it comes to supervising nurse anesthetists or CRNAs?

DR. WILLIAMS:

Um, I think that's, first of all, a great question to be asking yourself as a resident. A lot of the training that you're going through, you are sitting in your own room and not actively supervising, like you may be doing when you go out into practice and are leading the anesthesia care team. I think the first thing to remember is that CRNAs and AA, so our nurse anesthetist and anesthesiology assistants, are a vital part of the anesthesia care team. Um, I myself regularly work with CRNAs and I greatly respect them and enjoy working with them. I would advise residents to form good relationships with the mid-level providers, whether they be CRNAs or AAS, that they work with. I think that's the most important thing that you can do. I think there's a lot of value in knowing someone's skill set and developing trust. And that mindset of of teamwork is going to be beneficial for not only your patients, but also your daily work life. And I do think it is our duty as physicians to advocate for this care model that we know improves patient safety and outcomes, as we previously discussed with some of these studies. Oftentimes, advocacy can be overlooked because we have so much going on with studying for boards and reading up on our patients nightly and different procedures that that's something that falls to the wayside. But as we kind of settle into our roles as physicians and as anesthesiologists, I think this is an important aspect to be on a resident's radar and something that can affect their daily lives, whether they're lending their focus there or not. And then the last thing is that we owe it to our patients and the other members of this anesthesia care team to be an effective leader. And this does not happen without pointed effort in training. As we know as anesthesiologists, we have to be competent in clinical skills, but we also need to excel in communication, adaptability, team coordination, crisis management, and so much more. And it's important to remember that this is not a one-time training. It is a continual effort throughout our careers that can start before residency, but absolutely is important to learn during residency and beyond.

DR. BORG:

Yeah, I definitely think that's a crucial skill that, you know, you're right. It sometimes gets pushed to the wayside. But in terms of starting in residency and continuing that, moving forward, what sort of training have you seen out there for perioperative leadership? What what can we focus on specifically to make sure that we develop those skills that you've talked about?

DR. WILLIAMS:

Sure. So I'm not sure if everyone out there knows this, but the ACGME does mandate that all residents receive training in leading the perioperative care team. Programs from around the country accomplish this in many different ways. A lot of programs will offer a transition to practice rotation, so this would allow residents to practice supervising younger residents or other member of the care team, uh, to get that experience leading the care team. I think programs are doing a good job, but I also think it would be beneficial for there to be more consistency and more resources out there for programs to utilize. Obviously, each program is different in terms of staffing needs, opportunities, uh, resident numbers and how we're able to effectively train residents. So I think especially having resources out there for programs to be able to utilize and lean on, um, would be really beneficial for all residents, as well as the programs in general.

DR. BORG:

Oh, yeah. Absolutely. I definitely think that that's something really important to focus on. And so do you mind describing a few of those kind of innovative methods for kind of helping trainees get to the point where they can lead these perioperative care teams?

DR. WILLIAMS:

Sure. We had a lot of great examples from members of our committee and where they trained, and some contacts at different programs. One example is the transition to practice rotation, where residents rotate in the PACU so they will learn to manage post-operative issues and what it takes to be able to discharge the patient. They also experience running the O.R. board. So learning about staffing, efficiency, how to coordinate the care teams even beyond just the anesthesia care team and the OR care team as well. And then lastly, providing anesthesia and a supervising role. Other programs have a rotation where residents function as the resident clinical directors. So in this rotation, the resident would work under the supervision of the medical director of an outpatient surgery center to learn how the operating room functions, the logistics, planning and staffing, and other things that are needed to make an operating room run efficiently. So another programs offers anesthesiology leadership pathways, and this is a little bit more pointed to each resident's individual interests. So things like diversity, global health, equity, research, quality improvement, graduate medical education and advocacy. Luckily for our residents out there, there are so many different innovative methods being used by programs throughout the country, and I think it's definitely something worth asking about if you're a medical student listening when you are interviewing a residency programs to ask how their programs are training residents in leadership.

DR. BORG:

Yeah, I think the one that really caught my attention the most were some of the ones that took you out of the OR entirely, how are you talking about the board running or talking about different private practice, that sort of stuff. I think those are skills that are definitely worth developing and ones that, you know, I think would be an easy change to implement, at least in our program specifically, that would have lasting effects throughout the rest of all of our careers as residents and moving forward. So good examples. And I think, you know, anyone listening who sees things that they're interested in, like these are very tangible things you could bring up to our program to be like, look, great ideas that we could also incorporate. What about didactic resources or even just newsletter or social handles that we might follow and learn from? Can you share some of your thoughts on available resources for those that are interested?

DR. WILLIAMS:

Yeah, the ASA has some great resources that are available. So if you log on to the ASA site, make sure you're an ASA member--a lot of these resources are offered free of cost, and some of them are offered at an affordable charge. A couple examples are Leadership Academy as well as the ASA center for Physician Leadership Excellence. Um, the second one, specifically the center for Physician Leadership Excellence, I think would be great for residents because there are different tracks geared towards physicians at different points in their careers. So residents could use this specifically to target things that residents are working on rather than maybe an anesthesiologist later in his or her career. One program supports their residents participating in Lean Six Sigma training, and I think that's also something that individual residents could look into on their own if leadership is something that they're interested in. And then another place I would point you to is look into your state organization. Um, for example, our state here in Kentucky, our medical association, offers an annual leadership training program for physicians, not just anesthesiologists, but physicians everywhere that touches on the business side of medicine, the advocacy side of medicine, communication, and specific leadership modules. Um, the last thing I would say is to find a mentor whose leadership style you admire and learn from him or her. I think that can be extremely valuable. And if you're finding someone whose leadership style you like and want to emulate, chances are that person is going to be someone who wants to share with you and help you to become the best leader that you can be. One podcast you could check out is the American College of Healthcare Executives podcast. And then one other source I would point out is a woman named Brene Brown. She's had multiple Ted talks. She's written multiple New York Times bestsellers on leadership and the psychology behind that. So I think those are some good places to start for residents who are interested in learning about leadership and how to enact that in their lives.

DR. BORG:

That's awesome. Thank you. Personally, I really like the point. We all have that person that we look up to and emulate in residency, whether it be for their, you know, skill in the OR or their leadership style. And I think that's a really good point, to kind of go up to them and say like, hey, like, I really like how you've navigated this situation and kind of trying to emulate that. Um, I haven't necessarily thought of it that way, but I definitely think that's a good way to start at least kind of the process moving forward. All very, very good tips. I really appreciate you sharing all those.

DR. WILLIAMS:

Absolutely. Um, something that we're looking into, as a committee, the ASA Committee on the Anesthesia Care Team ,is is this something that programs want to have more resources? Um, we've recently put out a survey. It will be going to residents as well as early practice anesthesiologists and program directors to get your perspective on this so that if there is the interest, we can create some sort of database or programming out there. Um, whether that is utilized by specific programs or by individual residents who are interested in bolstering their leadership skills. So small plug. If you have gotten this survey, we would greatly appreciate your response so that we can make some programming that is relevant and wanted by you, the residents.

DR. BORG:

Yeah, we'll definitely all have to check our emails and fill that out as soon as possible. Any, um, kind of real-world concrete examples you've seen within your hospital, your residency program where you've seen things kind of come to fruition through kind of any of the methods that you listed above. I feel like an example always drives the point home really well.

DR. WILLIAMS:

I think our residents get a lot of really great experience with practicing supervising younger residents. We have also a lot of medical students who rotate with us. It's awesome to have so many great medical students interested in anesthesia and get to see them rotate through with us. Um, but especially in May and June, our interns rotate through our department in anticipation of starting their CA1 year and seeing especially our CA1s that were in their position not too long ago, now become the person that's guiding them through the operating room and leading them in their education and their patient care is a really fun part of my job as part of being a part of a residency program. So being able to see those residents go from the people that were being trained just a year ago to now being the leader of those younger interns and residents, I think is really great, and it's a really good experience for our residents as well to kind of take on that role rather than the role of the learner. Um, obviously they're still learning. They're learning about their patients, they're learning about leadership, they're learning about teaching. But it's a different role in that learning perspective than the intern who is on their first official anesthesia rotation as a physician. Another, uh, option that our residents have is utilized during their rotation at the VA. Um, we have one upper level and three CA1s there at any given time. So it's a really great opportunity for that upper level to be a part of cases with the junior residents to practice their supervision skills, with, of course, close oversight from all of our fabulous attendings that are out there at the VA medical center. So those are a couple of our options that residents have to kind of learn about overseeing. We also have some didactics, um, as part of our CA2 and 3 curriculum, about leading the healthcare team that kind of help teach the point from a non-hands on point of view.

DR BORG:

That's awesome. It's really interesting to hear kind of the specific examples, and it makes me even think kind of on a broader scale of things, not only within anesthesia but kind of medicine itself, how we can expand leadership and use, you know, our experience going forward. So thank you for kind of giving us all of that information.

DR. WILLIAMS:

Absolutely. And I think it's something that programs are doing really well in teaching leadership to our residents, whether that's in a formal way or more of an informal way. But I think there's always room for us to improve and make that training more effective, more efficient and more consistent.

So from a resident point of view, I would love to know what are you looking for in terms of leadership training as a resident?

DR. BORG:

I think really, you know, personally, for me, varied experiences is kind of something that I have broad interest in. For example, my program does one month of OR supervision, which is great, and I'm really looking forward to that. But, you know, I think kind of like you were mentioning, leadership is not just necessarily one facet or one component of our job. And so I think something that I'm looking for is something that I think maybe I can improve on looking for myself is kind of all the different ways I can integrate it into residency starting now. I don't necessarily need to wait until I'm a CA3 for that OR supervision month. Um, and kind of identifying where I can find leadership opportunities, be it in the OR, outside of the OR. Um, I think starting personally talking to some of my mentors and figuring out how they started and what tracks they went down would be helpful. And so I think kind of hearing all of the different methods of going about leadership has really kind of opened my eyes up to how much more there is to this specialty than just, you know, staffing your rooms and being a good anesthesiologist from a technical standpoint. Um, but it really goes much beyond that, working within the anesthesia team and then the medical team itself. So, um, I think what I'm looking for is just kind of that varied ability to kind of have a little bit of experience and a lot of different facets of leadership to kind of make a whole anesthesiologist one day, I guess, is the best way I can say it.

DR. WILLIAMS:

Yeah, I think those are great insights into things that you're interested in. And like everything, being a great leader starts with the interest in wanting to be a great leader and having that curiosity and desire for that skill set. Um, I think, you know, starting there is already putting you well on your way to finding that. So from your perspective, what kinds of programming or didactics or any other sorts of trainings do you think would be effective and beneficial for your learning?

DR. BORG:

Um, I'm really interested in some of the ASA resources that you've listed online. I think that's something worth delving into. Um, you know, kind of bringing that leadership education portion kind of more responsibility onto ourselves, I think is kind of what residents should be focused on instead of just waiting for our programs to necessarily provide it to us. So I definitely think that I'm going to take a look at those ASA, uh, you know, leadership opportunities and kind of education from that standpoint.

DR. WILLIAMS:

Yeah. Um, so as you look ahead to your future career, what challenges do you anticipate that you may have adjusting to anesthesiology after residency or maybe possible fellowship training? And how can we, as programs act to best mitigate those challenges?

DR. BORG:

Yeah, I think that's a really good question. And I think it's hard to know what the challenges necessarily are until you're in that situation. But looking forward, I can see how it would be challenging to either go into practice or a fellowship. You're in a new environment. You know, I think we are all very fortunate that, you know, after about six months of being in whatever residency or hospital system that we're in, we kind of understand how it works. We know the team. We know how to navigate that. And so to be thrown into being a new attending or a new fellow in a separate hospital and then trying to be a good leader on top of that, I think would be fairly challenging and I'm sure you know most or if not all anesthesiologists go through that at some point in their career. So I think even kind of introducing that element of unfamiliarity, be that, you know, maybe trying to get rotations at different hospitals as a leader, coming in to more of the outside or how we might at the beginning part of our practice or, you know, getting our hands in leadership of something that we might not necessarily be as familiar with. I think that would be good experience. If, you know, a resident were planning on changing the location of their practice from where they did residency to where they would want to practice. That being said, I'm sure some residents do stay on at their specific program. And so I think, you know, if programs could identify the residents that were interested in staying in their program to kind of get them into leadership early, you know, not necessarily waiting until graduation to get them on some of the committees within the hospital or some of the decision making groups, maybe have them as like a junior member on the staff that has, you know, kind of listening capacity to get people experienced as a resident. So that way once they start early training, they already kind of have some footing to hit the ground running and don't necessarily feel like they're all starting from, you know, spot zero. I think would be pretty helpful.

DR. WILLIAMS:

I think that's a great point. I know we have already offered jobs to some of our CA3s and fellows, and I can't wait to get them more involved. So I'm going to go ahead and take this as a resonance permission to start giving them possibilities. I love it.

DR. BORG:

Just don't tell them it was me if they don't want it, I love it.

Well, thank you so much for joining us today, Dr. Williams. I know this was really insightful for me to hear, and I'm sure that all of the residents listening to this will really appreciate kind of your take on anesthesiologist led leadership. This was really, really helpful to hear.

DR. WILLIAMS:

It was so much fun coming on this. It's a totally new experience for me and it's been really wonderful and I am so looking forward to seeing all the different ways that our programs out there are teaching our residents to be wonderful leaders.

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DR. BORG:

And to all of our listeners out there, thanks so much for joining us for this episode of Residents in a Room, the podcast for residents by residents. We hope you come back again soon.

VOICE OVER:

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