The Cost of Professionalism

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Roger A. Moore, M.D.

Professionalism means many things to many people. Certainly, for an anesthesiologist, the essence of professionalism lies foremost in being a physician, which translates into being ethically centered, scientifically founded and compassionately oriented in the delivery of medical care. Along with our motto of “vigilance,” this ensures the provision of the safest and highest quality of care as our patients travel through some of the most physically and emotionally stressful periods of their lives. Medical school teaches us the importance of patient autonomy and the need for a scientific basis in diagnosis and treatment. Residency furthers the physician’s education by expanding our knowledge base, as well as refining our technical skills, so that the myriad individualized medical judgments can be made intelligently for each patient, resulting in the highest quality anesthetic care. However, what seems to be lacking in the educational process is the establishment of involvement as a key element in the definition of professionalism. It is to involvement that I wish to direct my comments and the cost of that involvement in time, effort and money.

Involvement can take many forms in the practice of anesthesiology. Certainly, having a say in how an anesthesia department is run within a hospital requires involvement at both the departmental and hospital levels. Many anesthesia groups have suddenly been replaced by their hospital administration with what seems to be little or no warning. However, in many of these cases, early warning signs were present that were either not recognized or ignored. As we have learned for many “disease processes,” proactive intervention can lead to a healthy outcome. This means active involvement in hospital operations by serving on committees and task forces in order to stay attuned to current issues in your practice environment. This involvement offers the opportunity to have early input as procedures and practices are discussed and the ability to influence what may otherwise translate to unworkable situations. Often, gross misconceptions and unreasonable expectations can be tempered with an accumulated reservoir of good will that comes with institutional good citizenship. This cost can be calculated in effort and time.

Involvement also includes being active in organizations dedicated to furthering the professional standing of anesthesiology, both at a state and a national level. I am in the process of making assignments to ASA committees for the year 2009 and am amazed at the outpouring of volunteerism from members wishing to be placed on committees. I am even more astounded by the amount of time and effort put into the work of each ASA committee in furthering the stature of anesthesiologists through the promotion of issues in patient safety, payment, membership values, research and education. More importantly — I am encouraged by the level of volunteerism, the essence of professional involvement — that I am seeing among ASA membership. All these volunteers have chosen to further anesthesiology instead of using their time for personal pursuits. Similar involvement is found in the many anesthesiologists active in their communities, in their state and specialty societies, and in other national medical societies. Each of these activities helps, both directly and indirectly, to expand anesthesiology’s stature. Again, the cost is calculated in both time and effort.

Inherent in involvement is personal financial support of those organizations that impact our profession by becoming active dues-paying members. I find it sad that some anesthesiologists, albeit a minority, choose not to be members of ASA or their state anesthesiology society. The benefits of membership far outweigh the costs of yearly dues. The nonmember anesthesiologist is basically riding on the backs of the dues-paying member since they accrue the same economic gains that are hard-won through the volunteer efforts and dues-dollars of members. This attitude of getting something for nothing is the antithesis of what I would call professionalism, and a decision has been made by the Administrative Council that the cost of the many ASA membership benefits will be greatly increased to the nonmember. Though the greedy nonmember may still receive some of the benefits hard-won by our volunteers, most of the scientific and practice management educational materials will only be available to them at significantly increased cost. Also, I would argue that membership in the American Medical Association (AMA), as well as subspecialty societies related to one’s practice, should be integral to professional involvement. Though a case could be made that any society as large as AMA will never make decisions that are 100 percent aligned with personal beliefs, certainly most decisions are appropriate for all. In addition, having an organization representing a majority of physicians provides much more clout when dealing with federal agencies and payers. The costs of involvement are the amounts of the dues. What percent of income is appropriate for the monetary costs of professionalism? Historically, 5 to 10 percent of income would not have been outlandish, so present-day monetary costs are a bargain.

Finally, I would argue that support of the political process is integral to professional involvement. The presence of aggressive and unreasonable attempts to undermine patient safety demand that the profession of anesthesiology stand up and be just as aggressive in fighting back. What some groups cannot acquire by education and academic diligence is being sought by political fiat. All anesthesiologists need to be active in the political process to fend off these attacks. Having a fundraiser for a politician, getting to know your local politician on a first-name basis, and supporting relevant political action committees are all necessary if we are to gain access to the political process and be able to clarify the misinformation that is being disseminated. Our patients’ safety and the assurance of the future of anesthesiology requires each of us to be involved with our time, our efforts and our money.