Anesthesiologists are under a lot of pressure — ASA President-elect Dr. Mary Dale Peterson explains why

Mary Dale Peterson, MD, president-elect of the American Society of Anesthesiologists, spoke to Becker's ASC Review about challenges and changes in anesthesia, as well as ASA's strategy for addressing value-based care.

Note: Responses were edited for style and clarity.

Question: Does burnout affect anesthesiologists more or less than physicians in other specialties? Why do you think that is?

Dr. Mary Dale Peterson: Physician anesthesiologists fall in the middle of the various specialties in terms of burnout, although unfortunately we are in the lead when it comes to physician suicide. We have less stress in some areas, more in others. For example, we don't have the EMR documentation challenges that other specialties experience. But we are responsible for managing older, younger, sicker and more complex patients — who, thanks to technological advancements, are having surgeries and procedures that weren't possible previously — in an environment with increased production pressure.

Physician anesthesiologists are the final check before a patient is cleared for surgery. There is pressure to avoid cancellations, but we often discover right before surgery that the patient's pacemaker hasn't been checked, or labs haven't been ordered, for example. We're the only specialists who are there through all stages of surgery — before, during and after — and that is a lot of pressure. And, like other specialists, we also are under pressure to increase production.

Clearly, for the benefit of all specialties, there is a need to revise the Triple Aim to the Quadruple Aim to incorporate physicians' needs and alleviate burnout.

Q: What has gotten easier for anesthesiologists since you started your career in the field, and what has gotten harder?

MP: Since I became a physician anesthesiologist 30 years ago, equipment has become much easier to use. Where we used to have to do physics calculations, now we can dial in the percentage of anesthetic needed. We have better monitors, such as the pulse oximeter, and tools to assess airway management have improved. We now have more choices of drugs, including muscle relaxants and induction agents. Advances using ultrasound help us better identify specific nerves to target for nerve blocks.

What's become more challenging is the patient population. People are living into their 80s and 90s and continuing to have procedures. There's been a much greater focus on preserving brain health, which is a real challenge in these older patients as they undergo anesthesia and surgery. On the other end of the age spectrum, we are treating more frail pediatric patients, who can now survive after a mere 23 weeks gestation. There are numerous challenges managing babies born this early, because many also often have congenital anomalies. We also are learning how to safely manage anesthesia as procedures evolve — consider robotics, catheter-based procedures and the increasing number of complex procedures being done in the outpatient setting. It's incumbent upon physician anesthesiologists to have open and honest conversations with surgeons and patients before proceeding with a surgery. We have to be sure patients and their families truly understand the risk-benefit ratios.

Q: How is the transition to value-based care affecting anesthesiologists? How do you plan to address this trend when you take the reins at ASA?

MP: Value-based care is here. The government and payers are pushing for it, and physician anesthesiologists must be involved at a systems level. We need to be at the table in the push for higher quality, including prehabilitation, patient selection and education. ASA has a strategy involving education, training and research on the perioperative continuum of care to encourage and ensure physician anesthesiologists are involved, because we understand medical and surgical issues like no other specialist. I am committed to advancing ASA initiatives such as the perioperative surgical home and enhanced recovery after surgery programs. Through these efforts, we can really help the hospital team improve the pathway to ensure lower costs, lower readmission rates and higher patient satisfaction, which all work together in a value-based model.

Interested in participating in future Becker's Q&As? Email Angie Stewart at astewart@beckershealthcare.com.

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