May 1997
Navigation in uncharted waters: is anesthesiology on course for the 21st century?

Longnecker DE Anesthesiology 1997; 86: 736-42.

[ no abstract available ]

In the March 1997 issue of Anesthesiology, the text of the Rovenstine Lecture delivered by Dr. David Longnecker, Professor and Chairman of the Department of Anesthesiology at the University of Philadelphia, is published in full. Whether one attended the lecture at the 1996 American Society of Anesthesiologists meeting or not, it will be salutory to read this article. It is at once thoughtful and thought-provoking.

Dr. Longnecker paints the now all-too-familiar picture of the changed American system of health care, and the challenges it presents to the field of anesthesiology. Notable among these is the mounting pressure to replace M.D. anesthesiologists with nurse anesthetists, who, according to a presentation made to the 1995 Association of Academic Health Centers, "can perform nearly all the anesthesia tasks with minimal supervision and are nearly perfect substitutes for anesthesiologists." He points out that the number of positions filled by American graduates in National Resident Matching Program has declined by nearly 75% in the last five years: from more than 900 in 1991 to less than 200 in 1996.

The gauntlet thrown out by Dr Longnecker is that American Anesthesiology stands at a crossroads (or, as he quotes Yogi Berra: "When you come to a fork in the road, take it"). We can either retire to the relative tranquillity of the operating room, or set out on the stormier waters of perioperative care, taking major responsibility for preoperative preparation, recovery room and intensive care, acute and chronic pain management, as well as intraoperative care.

He suggests that the CA III track should eliminate the subspecialty rotations (which should be provided as a full fellowship), and concentrate on developing skills in perioperative medicine, working closely with our surgical colleagues in pre, intra- and postoperative care. And he envisions focusing research in anesthesia (under the gun of restricted discretionary funding) on three main areas: mechanisms of drug action, the scientific basis of perioperative medicine and the scientific basis of pain medicine.

Not all readers will agree with the proposals that Dr Longnecker advocates, but our response to the advent of managed care has been all too often an attempt to preserve income by doing more cases with fewer anesthesiologists. Dr Longnecker offers an alternative approach that could not only increase our value to hospital and plan administrators, but also attract the best and brightest graduates back into the specialty. Worth a read.

Return to the Current Literature Review Front Page