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KEY POINTS

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KEY POINTS

  1. The operating room remains the primary focus for the vast majority of practitioners.

  2. The practitioner’s primary responsibility is to ensure patients’ comfort and safety when they are exposed to the trespass of surgery and other invasive procedures.

  3. The intraoperative conduct of anesthesia has both immediate and long-term effects on patient safety and outcomes postoperatively.

  4. The provision of safe anesthetic care across geographically dispersed sites and encompassing wide ranges of patient health, in an economically responsible manner, is a challenge that anesthesiologists need to address proactively.

  5. The personal administration of every anesthetic is not feasible due to workforce limitations; team-based anesthesia care is required to meet the demand for anesthesia services.

  6. Meeting the personnel, safety, and cost demands of the future will require that providers overcome the political infighting between organized anesthesiology and nurse anesthesia, especially in an era when the majority of these individual providers work together effectively.

  7. Many believe it is important for the future of the specialty that anesthesiologists assume a broader role in perioperative medicine.

  8. Advances in knowledge and technology have created an opportunity for anesthesiologists to address the scientific questions at the core of the specialty as well as a variety of important clinical problems.

  9. Future opportunities for anesthesiologists include greater involvement in pharmacogenomics, business, and health care systems management and the development of new technologies, while continuing to lead and develop traditional areas, such as operating room anesthesia, critical care, pain medicine, teaching, research, and resuscitation.

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INTRODUCTION

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Anesthesiology arose as a medical specialty because the dangers associated with anesthetic drugs and techniques demanded administration by skilled and knowledgeable physicians. As safer drugs were developed and physiologic monitoring improved, the need for anesthesiologists was propelled by increasing surgical complexity and severity of patient illness, as well as by increasing expectations for patient safety. Whereas the original raison d’être for the specialty remains today, a variety of professional and economic factors have challenged anesthesiology and produced large “swings of fortune” during the past few decades.

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During the 1970s and 1980s, the emergence of critical care attracted many talented medical students to American anesthesiology training programs. However, these were halcyon days for anesthesiologists practicing in the operating room, where professional income was high, job opportunities were ample, and increasing surgical complexity demanded an increasing level of medical knowledge and skills. Thus, there was little incentive for anesthesiologists to expand their roles beyond the confines of the operating suites, and many trainees who were initially attracted by critical care subsequently practiced operating room anesthesia only. In contrast, anesthesiologists in Europe and Canada were expanding their roles during this same period in the burgeoning subspecialties of pain, intensive care, and resuscitation.

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In the mid-1990s, gloom beset anesthesiology in the United States as predictions, widely reported in lay press such as the Wall Street Journal, suggested that the need for anesthesiologists would decrease dramatically in an ...

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