As your new ASA Director from California and your new your representative to the ASA Board of Directors, it is my great pleasure to write a summary of the ASA Annual Meeting. First, I want to thank the previous ASA Director, Linda Hertzberg, MD, FASA. She has been a tireless, leader and advocate for CSA and ASA for 30 years! She is a mentor to many of us and her experience and professionalism will be hard to match. Dr. Hertzberg has served in almost every leadership position within the CSA including Speaker and President, as well as having been a productive member of countless ASA committees. Arguably, her greatest achievement is the new standing ASA committee on Women in Anesthesia. It started as a dream and an ad hoc committee that has now morphed into something wonderful and permanent. Her focus on diversity at the ASA and CSA has brought about changes that will long outlast her involvement. Thank YOU, Linda! I am very aware of how difficult it will be to fill your shoes.
The first virtual ASA Annual Meeting kicked off unofficially on Thursday October 1, with the online California and Western caucuses hosted by the CSA on Zoom. The official Annual Meeting began on Friday, October 2. The meeting was historic with its goals and aspirations, and unforgettable with its chaos in the House of Delegates.
Putting on a virtual annual meeting was a momentous task that produced some unexpected successes and some predictable and spectacular melt downs. Boasting the largest attendance of any ASA annual meeting of over 15,000 attendees, the size and scope were impressive. When information was flowing in one direction (from the ASA, lecturers, and leaders to end users) the system worked well. However, when it came to interaction, deliberation, and amending policy positions, all required for effective and representative governance, the system became unworkable and required early adjournment and a mulligan.
The educational component of the meeting was excellent! It was a treat to hear the best and brightest speakers and professors presenting the most current information about the specialty we all love and practice! All subspecialties were represented, and the information was broken down into easily accessible learning tracks with plenty of MOCA credits sprinkled in. The depth and breadth of the information available was spectacular, and it is still available through December 31 for up to 27 hours CME credit. All of the live lectures were recorded for on-demand consumption, so it is easy to get the information you need to practice today and you can do it in your pajamas at any hour of the day or night.
In the past, one had to choose between excellent lectures taking place simultaneously, only to find out the one lecture you wanted to hear was full or sold out (after you finally found the lecture hall deep in some obscure wing of an endless convention center). The on-demand, virtual environment for lectures, panels, and point/counterpoint discussions is a definite positive for the virtual annual meeting. Also impressive were the special lectures.
Starting with our own Surgeon General, Jerome Adams, MD, MPH, listening to him speak makes one proud to be an anesthesiologist! The keynote speeches by NIH physicians, Frances Collins, MD, PhD, and Deborah Birx, MD, (Corona Virus Task Force member) were timely and excellent! The Rovenstine lecture was delivered by Joanne Conroy, MD, who has been a champion of diversity (including her leadership in Times Up Healthcare) and expert on disruption. Her lecture was also timely and very well received. The CSA was well represented by speakers, moderators, abstract, and lecture presenters.
One incredibly special moment from the Annual Meeting: “our own” Patricia Kapur, MD, (former Chair at UCLA, former CSA officer, and former Chair of the ABA) was awarded the 2019 ASA Distinguished Service Award (our highest honor)! Congratulations and well deserved!
As an added bonus, California resident and former ASA and CSA President, Daniel Cole, MD, FASA, was nominated for the Distinguished Service Award for 2021. Congratulations Dr. Cole!
Elections: There were no contested elections. The slate of candidates for the ASA Administrative Council are as follows:
President: Beverly Phillip, MD, FASA
President Elect: Randy Clark, MD, FASA
First Vice President: Michael Champeau, MD, FASA
Speaker: Ronald Harter, MD, FASA
Vice Speaker: Patrick Giam, MD, FASA
Secretary: Kenneth Elmassian, MD, FASA
Asst Secretary: Kraig S de Lanzac, MD, FASA
Treasurer: Donald Arnold, MD, FASA
Asst Treasurer: Jay Mesrobian, MD, FASA
Vice President for Professional Affairs: Jeffrey Meuller, MD, FASA
Vice President for Scientific Affairs: Andrew Rosenberg, MD, FASA
House of Delegates
The House of Delegates could only be described as a slow-moving train wreck. The ASA chose to use a dual platform for the House of Delegates and Reference Committees which included one platform for the presenters/moderators and another platform for testimony and deliberation. This dual platform model created exceedingly long lag times between testimony and time the audience/speakers were hearing the testimony, not to mention the difficulty in changing platforms to be able to testify or suggest amendments to positions.
The problems were foreseeable, as the same dual platform model was used for the August ASA BOD with similar difficulties. Despite the valiant efforts of Vice Speaker Patrick Giam, MD, FASA, who showed a Zen like patience for the lag times and incompatibility of the model with deliberative governance, the House declared a recess early, after only approving elections and some consent calendar items. Thus, the HOD did not act on several issues of concern to the organization including the following:
A statement on distraction in the OR. The reference committee report with suggested language can be found here.
A statement on the environmental sustainability/compatibility of anesthetic practice, especially with regards to the green house effects of some of the inhaled anesthetics. This was part of the Ethics Committee’s documents, and discussion at the BOD meeting in August felt that this belonged elsewhere. This is not the first time this year that this topic has been discussed by CSA members. Earlier this year, a CMA resolution was proposed by a non-anesthesiologist without involving the CSA. The Reference Committee report, including proposed changes from the Western Caucus, can be found here.
A statement on fatigue in the OR. This was probably the most contentious issue. The reference committee can be found here. The issues discussed passionately included physicians who are genuinely concerned that fatigue creates impairment in anesthesiologists, and if a strong position on the issue is not taken by the ASA, outside regulatory agencies will do so (this exact situation happened with airline pilots). Several members expressed appropriate concern about creating a restrictive statement that will place anesthesiologists at risk if they are needed to work after call.
A date for the ASA House of Delegates to resume deliberation on these important issues has not yet been posted, however, Christine Doyle, MD, FASA, CSA’s Immediate Past President, was appointed to a special ad hoc committee to review options for the ASA House of Delegates. Stay tuned and please let us know your thoughts. The ASA represents you!!!
Budget and Finance
The ASA is a membership-driven organization and normally receives financial benefit from the Annual Meeting. Since many of our ASA members are under financial stress because of the COVID crisis, there is concern about the forward-looking financial health of the organization. While the ASA is currently financially healthy with over 70 million dollars in reserves, the ASA is looking to cut costs where it can and consider other sources of non-dues revenue. The ASA BOD did approve a 2021 budget of 46 million dollars which includes a deficit of 3 million dollars.
At the annual ASAPAC donor’s lunch, Charlie Cook gave a great analysis of the current political environment and the upcoming election.
California was recognized for our win in the Day of Contributing Challenge with the most money raised in one day for ASAPAC ($107,000 dollars). However, Texas held on to the Alabama Cup for the second year in a row with the most dollars raised throughout the year (Texas raised $193,806 dollars and California came is a very respectable second at $170,173 dollars). Thank you to all who supported ASAPAC!
On the issues front: ASA rolled out their review of the Medicare payment inequity situation which was authored in part by former CSA Past President Jonathan Pregler, MD, can be accessed here. The ASA is aware of the importance of this issue to members and is putting as many resources as possible into this fight. Many of the surprise billing pieces of legislation use Medicare as a benchmark, and with the possibility of Senate and White House changing parties, there is a real possibility of Medicare for all or Medicare for more.
The ASA is also aggressively fighting the emergency order in the VA system to allow nurse anesthetists to work unsupervised. The ASA knows that having a physician anesthesiologist involved in the care of a patient is mandatory for patient safety.
Other advocacy issues include: CASPR (legislation to help with payment for anesthesiologists who helped during the pandemic in the ICU and throughout the hospital); and Resident Debt Relief. Many anesthesiology residents are significantly in debt as the result of the cost of medical education. The economic downturn has made this situation even worse.
Humans are social creatures, and everyone misses the camaraderie and networking that occurs with face to face meetings. We all miss the opportunity to craft policy positions and give testimony in real time and the ASA will have to work to find a platform that will allow its members to hold an effective virtual House of Delegates. On the positive side, the virtual format does work well for delivering state of the art techniques and information about the specialty we all love and practice.