Christina Menor, MD, president-elect of the California Society of Anesthesiologists joined Becker’s to discuss the field’s most exciting developments and biggest challenges in the near future.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the most exciting development in anesthesia right now?
Dr. Christina Menor: Our focus is always on safety and patient outcomes. We see several trends that are exciting for advancing patient care in the anesthesiology specialty. The first is how anesthesiologists have been on the forefront of designing and deploying opioid-sparing approaches with patients. There is increasing use of [enhanced recovery after surgery] protocols and regional anesthesia — the implementation of these multimodal strategies reduces complications and recovery time, and minimizes the need for opioids. With the continuing opioid crisis, anesthesiologists have been helping educate patients and providers about safe opioid use, and also helping patients understand how fentanyl that is used safely in medical settings as part of an anesthetic treatment plan differs from street drugs.
Additionally, the anesthesiology specialty has been working to reduce maternal morbidity and mortality through best practices and use of quality metrics. Overall, the healthcare community must continue to prioritize this serious issue, particularly for Black women who are three times more likely than white, Asian and Hispanic women to die during or immediately after pregnancy, according to the CDC. Anesthesiologists are working to educate patients about epidurals as a safe strategy for pain relief during labor, particularly for higher risk laboring women to help avoid general anesthesia, when possible, especially during cesarean delivery. We are also taking steps to use prophylactic medication to try to prevent low blood pressure during cesarean procedures and taking extra precautions for women who have comorbidities like hypertension that increase the likelihood of cesarean deliveries. The California Society of Anesthesiologists is collaborating with the California Surgeon General Diana Ramos, MD, on her “Strong Start & Beyond” initiative to reduce California’s maternal mortality rate 50%, and we look forward to continued progress on this critical health issue.
It’s also important to recognize the transition to providing more and more surgical procedures in the ASC setting, and how safe anesthesia care is a critical part of this transition. ASCs provide a more affordable, more accessible option for patients needing outpatient surgery, and advances in medical techniques and pain management are allowing a broader set of procedures to be performed in this setting. As this occurs, anesthesiologists continue to provide an essential role in ensuring the highest standard of safety and quality care for patients.
Q: What is the most concerning development/problem in anesthesia right now?
CM: Decreasing reimbursement rates for anesthesia from both Medicare and private insurance companies is creating a serious problem. Generally, there is a shortage of both anesthesiologists and [certified registered nurse anesthetists] across the country, and declining payment for services harms the ability to attract a future anesthesia workforce. We need stability in the system for payments to ensure long-term sustainability for anesthesiology, especially given the long years of training and high levels of debt that must be incurred before an anesthesiologist can start practicing. At the same time, it’s important to pay attention to physician wellness. High levels of physicians are reporting burnout with many indicating they are considering reducing hours or leaving medicine. We must prioritize physician wellness now more than ever and look at strategies to increase efficiencies, manage workflows, combat the risks for burnout and try to promote an environment that attracts and retains the future anesthesiology workforce that is needed to meet growing patient demands.