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

  2. The anesthesiologist's primary responsibility is to ensure patients' comfort and safety when they are exposed to the trespass of surgery.

  3. The intraoperative conduct of anesthesia has effects on patient safety and comfort in the postoperative period.

  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. It is arithmetically impossible to provide a fully trained individual anesthesiologist for every anesthetic procedure.

  6. Meeting the labor, safety, and cost demands of the future will require that we overcome the political infighting between organized anesthesiology and nurse anesthesia.

  7. Many believe it is important for the future of the specialty that anesthesiologists increase their commitment to critical care medicine.

  8. Recent advances in knowledge and technology create an enormous opportunity for anesthesiologists to address the scientific questions at the core of the specialty as well as a variety of important clinical problems.

  9. Apart from traditional areas of involvement, such as operating room anesthesia, critical care, pain medicine, teaching, research, and resuscitation, there will be future opportunities for anesthesiologists in pharmacogenomics, health care systems management, and new technologies.

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Anesthesiology arose as a medical specialty because the dangers associated with anesthetic drugs and techniques demanded that they be administered 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 most of the trainees who were initially attracted by critical care subsequently practiced operating room anesthesia only. In contrast, anesthesiologists in Europe and Canada were consolidating their positions 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 anticipated managed care environment. Medical graduates were discouraged from pursuing careers in anesthesiology, and residency programs contracted dramatically. In the last 10 years, US anesthesiology programs have enjoyed a revival, and many talented medical graduates have chosen to enter the specialty. Another encouraging recent ...

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