Co-authored by
Adam Milam, MD, PhD - Cedars-Sinai Medical Center
Miriam Sawary, MD - UCLA
The long and often grueling process of American medical education continues to produce superlative clinicians, but excellent clinical care itself is not adequate in the current U.S health care delivery system. Well-intentioned but misguided and onerous legislation, regulations and requirements can paradoxically create impediments to anesthesiologists doing the vital work of caring for their patients “when seconds count”.
On April 24, 2019, physician anesthesiologists gathered in Sacramento with the CSA 
Delegation for the California Medical Association’s (CMA) Legislative Day with the goal of educating lawmakers and their staff about many of the issues challenging our specialty, physicians, and the public at large. The day’s delegation included Drs. Poage (Chair, Legislative and Practice Affairs Division), Doyle (President-Elect), Yost (Past President), Zakowski (Past President), Sibert (Immediate Past President), Primack (Vice Chair, Practice Management Committee), Jha (Director, Early Career Practice Forum), Butler (Executive Director) as well as KP Public Affairs (CSA’s lobbyists) and three residents, Ryan Gamlin, CA-1, UCLA, Behrod Katebian, USC, and Adam Milam, CA-2, Cedars-Sinai. The State Capital was especially busy due to the hearing for Senate Bill 276 (Senator Pan), requiring vaccine exemptions to be approved by public health officials, with members of the CMA Delegation testifying in support.
In addition to supporting CMA’s legislative agenda, the CSA Delegation also met with legislators to advocate for two vital issues: ensuring access to in-network anesthesia providers and licensure for Certified Anesthesiology Assistants. This year, CSA sponsored AB 1174 (Assemblyman Wood) which would address an unintended consequence of AB 72 (passed in 2016). AB 72 provided protections for patients, it sought to avoid leaving patients with a “surprise medical bill” from out-of-network providers providing non-emergent services at in-network facilities. Unfortunately, insurers have used this legislation to terminate existing contracts with anesthesia provider groups or demand significant reductions in reimbursement rates. Members of our delegation were able to provide personal examples of how AB 72 has negatively impacted their practices. AB 1174 is designed to hold insurers to account in the event that they terminate a contract by demonstrating that their physician panel can continue to provide sufficient services before terminating contracts. Many of the legislators that supported AB 72 were unaware and troubled by the impact the legislation had on in-network providers.
The second agenda item was the introduction of Certified Anesthesiology Assistants (CAAs) to California in order to help address the shortage of anesthesia providers. CAAs have been around for nearly forty years and practice in 19 states, functioning similarly to Physician Assistants for Anesthesiologists. CAAs must have a master’s degree that ranges from 24 to 29 months, including 2000-2500 clinical hours, with credentialing under the state medical board and mandatory re-certification every six years. CAAs operate as part of the Anesthesia Care Team under the direction of a Physician Anesthesiologist. CAAs would extend the reach of Physician Anesthesiologists, helping to alleviate a shortage of those qualified to administer anesthesia, as our services are provided almost every location in the hospital.
During lunch, there were several presentations from CMA leadership that detailed the legislative achievements over the past year. These presentations were followed by an engaging and energetic speech by Governor Gavin Newsom. His speech highlighted his 
healthcare agenda and some his accomplishments in his first year of office. Governor Newsom, who said he wants to be known as the “Healthcare Governor,” mentioned his first act in office – signing an executive order directing the state to negotiate prescription drug prices for the 13 million Californians enrolled in Medi-Cal. The governor plans to partner with county agencies -- and even other states -- to increase the negotiating power for prescription drugs. Other accomplishments included loan repayment for primary care physicians practicing in underserved areas, expansion of residency positions, and increasing reimbursement rates for providers. The Governor concluded with a firm promise to continue to work with CMA to improve access and quality of health care for Californians.
Attending the CMA Legislative Day was a valuable experience for our resident contingent. The residents in attendance were able to learn about important issues affecting all physicians practicing in California, and those specific to anesthesiologists. Many of us were struck by our capacity to educate and inform legislators and their staffs on issues of vital importance to us. Often, we found that legislators were aware of these issues prior to meeting with the CSA and CMA delegations, highlighting the importance of advocating for our field at the state and national levels, as well as the importance of supporting CSA’s legislation efforts through efforts like legislative days and financial support of CSA’s political action committee, GASPAC. We extend our sincere thanks to CSA for their continued commitment to resident participation and advocacy for our profession.