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Style Points with Ron Harter, ASA President (Live at OSA!) · Style Points

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  Hello anesthesia enthusiasts, and welcome to a very special live episode of Style Points,
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  recorded as the keynote address at the 2024 Ohio Society of Anesthesiologists meeting.
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  My guest was Dr. Ron Harter, professor of anesthesiology at The Ohio State University
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  and current president of the American Society of Anesthesiologists, which, for our medical
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  students, is the nation's largest organization of physician anesthesiologists.
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  Yes, you heard right, the president of the ASA agreed to be my guest on Style Points.
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  Now, some of you might be wondering, how did I get the president of our national society
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  to agree to be on my podcast? I'm not sure. However, Dr. Harter was very gracious with
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  his time and his answers. Without further ado, live from the OSA, it's Style Points
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  with Ron Harter, ASA president.
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  My name is John Crow. I've been to this meeting for many years, and about a little less than
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  a year ago, I started a podcast called Style Points. And don't worry, I'm not making any
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  money from this podcast. I don't run any ads. It's primarily to serve as an educational
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  venue for residents, medical students, and sometimes faculty. So if you're interested
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  in podcasts and like listening to things like ACREC, which I was a featured guest on, you're
• 1:29
  welcome to take a look through the QR code there or just search for Style Points in your
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  favorite podcast player.
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  Now, when I first talked to Ron about doing the keynote, the program director for this
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  program, I asked him if he wanted to do his own lecture of his choice. And he said, it
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  seems like it'd take a lot of time. I don't really want to do a lecture. So I said, well,
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  what if I just asked you some questions and did it in a podcast format? And he said, you
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  know, that sounds okay. I think I could do that. So here we are. And so we're going to
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  talk to Ron about some of his philosophy on life leadership and being the ASA president.
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  Although I wanted to say that this is my own project and it's distinct from anything OSA
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  related. So it's specifically just my podcast that I don't make any money from. So we'll
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  get started.
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  So does that mean I'm also not making any money from this? Because I'm not sure I would
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  have signed up for this.
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  You know, I think that's a fair point. Maybe we can work something out under the table
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  a little bit later.
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  Yeah, sounds good.
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  As long as we don't have to buy up a disclosure slide. I wonder, to get started, can you just
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  start by sharing a bit about your journey into anesthesiology and what inspired you
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  to pursue the specialty in the first place?
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  Sure. Yeah. I, when I started in the medical school, I knew I wanted to be a doctor of
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  some type from like five years old on. I don't know what it was, but it just was something
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  I wanted to do. But I didn't know what necessarily what specialty. And then in medical school
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  between my first and second year, when I should have been doing research, I was, I worked
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  as a orderly, they called it then like patient care associate in a kidney stone treatment
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  center here in Columbus. And so I saw a lot of urologists and at that time, the, you know,
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  the shockwave lithotripsy was intense enough that you had to be there be a general anesthetic
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  or they were doing a fair number of them under spinals.
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  And so I got to see a lot of urologists and a lot of anesthesiologists and the anesthesiologists
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  were doing a combination of spinals and generals. And I just was fascinated with what they,
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  with what they did. And then as I talked to more and more of them, they all seemed to
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  be very nice, well adjusted, happy, normal people. And so I said, you know, this, there
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  might be something to this. So then when I had the opportunity in my third year to do
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  an elective in anesthesiology, I did that and I was totally hooked and very happy with
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  the decision I made.
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  So you feel like it was better to intubate from above than from below.
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  Exactly.
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  That was sort of the decision point there. Makes sense.
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  Yes, very true.
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  It seems like becoming ASA president probably takes a lot of time and effort and emails
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  and going to a lot of meetings. One of my residents has shared with me actually that
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  she wants to be the president of the ASA someday. For her benefit, how did you get here? Did
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  you always know you wanted to be the president of our society?
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  Not necessarily, although I got involved in ASA very early on as a resident. I was elected
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  to serve on the ASA resident component governing council and that gave me a very early insight
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  into ASA, how the organization works and gave me the opportunity to meet various leaders
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  within ASA who I just was without exception really impressed with just their commitment,
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  their dedication, their knowledge. And I said, you know, that's, I would like to be that
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  when I, you know, as I advance in my career. And so, you know, do some level of involvement
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  within ASA as an organization. But you don't necessarily, I don't think at that early
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  point say this is exactly the path I'm going to be on, but more just how can I be involved
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  and engaged in our specialty society. And then as things progress, then you start to see
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  a path forward where well maybe, you know, this next step will take me to another step
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  to another step that I can do that. So it starts taking shape, you know, a few years
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  into that. But my advice to your resident would be I think without, with very few exceptions,
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  I should say, people who are leaders within ASA, they start with or concurrently at least
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  with leadership within their state component. I don't know that, you know, there's 12 officers
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  within ASA. I've, almost all of them, if not all of us are former presidents or future
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  presidents of our state components. There's at least one that I know of that will be president
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  of her state component in another year or so. But that really creates the foundation
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  and the depth of understanding of the issues that we face. And frankly, a lot, as I'll
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  talk about in the ASA update, many of the advocacy issues that we face, payment issues
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  and scope of practice and all those things, those battles are very largely being waged
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  at the state level. And so it's invaluable to be a leader within ASA to bring that experience
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  from what you've learned in the state level.
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  So can you tell me about some of the most influential experiences that you've had in
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  your career, maybe some that have shaped your leadership style or the way that you approach
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  problems? What are some of those experiences to you?
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  So in those various leadership roles, I had the opportunity as I was learning my own leadership
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  style and skills, I learned a lot by the people who were leaders when I was in various roles
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  sort of moving up the ranks both within the department as well as within ASA. And I often
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  feel like you learn, you might learn more from bad leaders than you do from good leaders
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  because it gives you a very good example of how did that make me feel when a leader maybe
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  was dismissive or didn't really respect me or whatever. And so I tried to not be the
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  bad leader while emulating the things in good leaders.
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  So and again, within ASA specifically, the past presidents that I've had the opportunity
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  to interact with over the years have just been tremendous mentors and they have given
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  me invaluable advice of things to prepare me for being president and some of the things
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  to expect. And so that's been just tremendously valuable for me.
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  And then, you know, but I think both of my leadership at the department level and my
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  leadership within ASA, I think those each complemented each other because there are
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  some things that are unique to a department that I think you can extrapolate to ASA type
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  of issues but also things that I've learned within ASA that have helped me with managing
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  a department.
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  You mentioned some of those bad leaders that you learned lessons from. I wonder if you
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  could just go ahead and list all those people for me.
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  Yeah, and I could give you their cell phone numbers.
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  Yeah, right. We can go ahead and put them up on the PowerPoint.
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  So when you came in as president of the ASA, I'm sure with all of your campaigning and
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  everything else, you had some goals for the organization. Can you talk a little bit about
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  what some of those goals that you had for your presidency and for the organization were?
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  Yeah, yeah, great question. So one of the pieces of advice that I got from a past president
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  was and I was I think maybe first vice president at the time. So a couple of years ago was
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  identify maybe one at most two things that you want to accomplish that are in addition
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  to or additive to the things that you do as president because the things you do as president
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  are there's a lot on that list that you have to do and you can you can be very busy and
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  certainly a lot of your time spent on doing the things that the ASA president needs to
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  do. You do a lot of traveling to especially society meetings. There's a lot of zoom calls.
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  There's a lot of things that you know new legislative issues that come up and scope
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  of practice issues that come up and that keeps your calendar pretty full. And that's fine
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  if you get through the year and you just have done you know checked all the boxes crossed
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  all the T's and dotted the I's of the things that the president needs to do in that role.
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  But it's a missed opportunity if you don't have some other thing. And so for me that
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  thing was wellness and having wellness resources for our members. I you know that's something
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  that I've had an interest in for quite a while. And within ASA I there's various efforts that
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  I've been involved in and initiatives that I've led around around wellness. And but I
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  felt like there was ASA had compiled some good resources about that. But there was I
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  think more opportunity there. And as I was president elect you know what what my dream
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  was was can we provide a service for members where they can access mental health resources.
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  I didn't know quite exactly what that was. And we initially looked at can we build something
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  like that within ASA and to really do that and do it well and to have the appropriate
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  expertise and everything that was going to be a you know really incredibly big lift to
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  try and put all that together. And then as we were having discussions with myself and
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  kind of some other leadership within ASA both physician as well as ASA staff leadership
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  that have interest in this area we became aware of this safe haven entity that was started
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  out of the Medical Society of Virginia for physicians to provide confidential counseling
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  coaching those types of services. And then as they had really gotten that well established
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  within the Medical Society of Virginia then they were starting to offer this more broadly
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  to other physician groups and the American Society of Clinical Oncologists as this came
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  to our attention they had just launched a pilot for their members to give them access
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  for a you know for a small fee to have access to all those safe haven programs. And so then
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  it was a matter of you know how can we provide this for our members you know how do we pay
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  for it do we ask the members to pay full freight themselves and that may be fine for an established
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  anesthesiologist but for somebody who's in training or newly out of practice you know
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  as we looked into it the discounted rate that we got from safe haven was $333 a person and
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  thinking back to my residency days and you have to pay it all at once you can't like
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  you know spread it out over a year. So that would have been a heavy lift certainly for
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  me in my residency and so we were able to coordinate with our ASA Charitable Foundation
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  that they offset a lot of the cost and then so reduced by more than half so for $149 you
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  get all of the resources of safe haven and so we so we were able to launch that in June
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  we've got now several people who have signed up they're still and I'll talk about this
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  some of the ASA update but that's that's something that I you know feel very good about that
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  I was able to identify something and actually get it across the finish line during my presidency
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  but it it required but the other advice I got is don't wait to your president year to
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  start teeing things up because by the time you get all of that all of those preliminary
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  things done you're no longer president and you no longer have that that pulpit to to
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  preach from and to get those types of things in place.
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  Physician wellness and taking care of our own is a topic that's gotten more and more
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  popular over time because I think it's become more and more relevant over time increasingly
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  I think anesthesiologists and other health care professionals are all stretched burnout
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  is a big issue.
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  I wonder what have been some of the experiences that you've had in your personal life in
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  your background that have influenced sort of your approach towards aiming towards physician
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  wellness as one of your main ideas of focus.
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  Yeah so great question.
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  When I was a resident I trained at Georgetown and it was at the time was a pretty small
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  program and there were like eight residents in my class and so everybody knew everybody
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  very well and during the time my three years in residency at Georgetown two of our chief
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  residents and you know one in two successive years what had been diverting fentanyl for
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  their own use and so in a program that size to have two colleagues that experienced that
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  that immediately sort of pushed me in a direction of you know the impairment issue and certainly
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  related to that is the stress and the burnout and you know they're all definitely intermingled
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  issues.
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  And so then as as my career progressed and I was an officer within ASA there was a big
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  expose if you will in the Washington Post talking about physician suicide and there
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  were several bullet points and this was kind of an unscientific unofficial tally of not
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  even really a survey but this physician had been tracking deaths by suicide among physicians
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  and by her data male anesthesiologists were the highest group of you know of any specialty
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  you know especially by gender of reported death by suicide among physicians.
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  So then that was what prompted ASA to create a committee on physician well-being and initially
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  it was suicide then it kind of rolled into well-being and I was asked to lead that initiative
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  because I had kind of had some interest in that already and and so that then I think
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  further propelled me into this and the more that I became aware of the issues over the
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  years the more that I realized this is really a significant challenge and it's only gotten
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  worse as far as burnout and so forth over the years.
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  So it's one of those things I think the more that you are aware of it the more that you
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  can't just ignore it and you know pulled into it further.
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  I appreciate you sharing that.
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  I wonder if you could talk a little bit about some of the success stories that you might
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  have seen about physician wellness through the program that you created.
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  Yeah so as far as the program we're starting to get now some anecdotal reports back.
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  It's you know it's by design it's you know people enter it confidentially so ASA doesn't
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  know who's signed up but if they want to volunteer to us you know feedback of hey this was great.
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  So we're starting to hear some of that we we just got a great testimonial recently from
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  somebody about the coaching aspect of it that that it was they found it tremendously valuable
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  and and they were able to apply a lot of the things that they had learned from their coach
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  and the coach directed them to some further resources to read on on on coaching and and
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  sort of managing you know various leadership challenges and things.
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  And so so I think that's that's a that's an aspect of it that I think is you know has
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  a I think an appeal that's sort of added to or maybe even a little bit separate from the
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  wellness issue is that even if you feel like my life's great I have no stress at all you
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  know that it's got those kinds of resources and I've I've heard some feedback from people
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  just sort of off the record that they've that they you know they they've enrolled in safe
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  haven and they have really found it to be a terrific asset and a resource for them.
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  We had a member just I guess it was last weekend that called ASA that they were they were sort
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  of contemplating harming themselves and they were directed then to safe and this person
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  was not yet signed up with safe haven but we reached out to safe haven and their counselors
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  spoke to this person and and by the time I got in the loop I talked to him as well and
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  he was not at a point anymore where he felt like he was at you know risk of harming himself
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  but you know so those you know those kinds of things are are what's out there and so
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  you know I I you can't measure I don't think what the benefit will be from safe haven but
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  it doesn't take too many of those stories before you say what you know it's it's it's
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  doing what it's supposed to do.
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  Absolutely this is a amazing program and I would encourage any of you who might be feeling
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  that way to take a look that's that's what it's there for.
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  One of the things that you mentioned was coaching and coaching has been sort of a big buzzword
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  that I was wondering if you could give a little bit of your expertise towards what's the difference
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  between coaching and mentorship and how does that all work.
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  Yeah great question so you know I think they they're very closely related I think that
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  mentors tend to generally need to be in your same area of expertise because they can really
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  tell you you know here's the here's you know here's the opportunity that you ought to pursue
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  that will then put you on the next step of the path that you're you're wanting to go
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  on and I know that because that's something that I did myself.
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  Coaching is a little bit more it can be somebody in your own specialty but but it's more you
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  know how do you deal with you know I I tend to avoid difficult conversations with people
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  even though I know that that's what needs to be done.
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  How do you you know how do you get yourself to get to that point and what are the what
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  are the things that can help you to have those difficult conversations or you know what are
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  what are some of the just general leadership challenges around communication or whatever.
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  So it's more broad application of of the skills that will make you an effective leader not
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  necessarily to be if I aspire to be president of the ASA what are the steps within ASA I
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  need to take to do that that's more of a mentor and certainly as I reference like the past
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  presidents within ASA those were people who were mentors to me but not necessarily coaches
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  you know so I guess that's that's what I see as the distinction but there may be others
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  who have better insight on that than I do.
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  Standing around here this morning and talking to everybody there's a lot of residents and
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  medical students and younger faculty that we have here that represent the future of
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  our specialty and it's really fantastic to see you all here.
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  What I would like us all to benefit from is Dr. Harter's next answer here what advice
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  do you have for those young anesthesiologists or people who are about to become anesthesiologists
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  in terms of taking leadership roles in terms of how to best build your career starting
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  right now.
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  Yeah great great question so I think that as we've already sort of touched on having
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  mentors is is really important and as I said mentors plural you know you can't just have
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  a mentor who's going to be expert in you know every facet of your career that you're going
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  to want to pursue if you want to be you know a nationally recognized educator in anesthesiology
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  that's going to be a different mentor probably than somebody who can advise you on how do
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  I get to be in leadership roles within ASA.
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  So having mentors that you can go to and ask questions of and I think you know one of the
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  things that I've you know was kind of slow to learn myself but it's advice that I give
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  to people when they when they ask for my input is you have to be comfortable and learn that
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  you don't have to say yes to everything because I think there's certainly in my own case anything
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  that anybody said hey can you do this can you do you know whatever it was sure yeah
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  I can do it because I wanted to be viewed as the go-to person who's able to to do whatever
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  solve any problem or or work on any project that came along but it you know there there
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  the reality is there is a finite number of hours in the day and there's a finite number
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  of things that you can really do well and I you know I eventually got to the point where
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  I realized that you know the more that I take on the more that I'm taking away from some
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  of the other things that I've already committed to not to mention you know time you know with
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  with family and doing something other than work during every waking hour so so and that's
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  where I think a mentor can be very helpful because they can help to discern between you
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  know you've got a couple opportunities and maybe you take the new opportunity but to
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  do that you need to offload some of the things that you're already doing and I think that
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  that's you know that's that's that was a hard lesson for me to learn but once I finally
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  recognize that and you have to have enough self-confidence that I can say no to something
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  and it's not like the faucet will shut off and nobody will ever ask me to do anything
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  ever again and I think if you give a thoughtful response to it that gosh it's it'd be a great
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  opportunity but I just you know I don't feel like I could commit the time to it you know
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  certainly because I've had people you know give me that response when I've asked them
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  to do things either in the department or ASA type of things and I I very much respect that
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  answer and I'd much rather somebody tell me that they don't feel like they have the bandwidth
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  to do it then to sure I'll do it and then you know they don't respond to your emails
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  because they're constantly doing other things and they can't commit really fully to what
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  you've asked them to do so I think that's that would be probably my single biggest piece
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  of advice is is knowing when it's okay to turn down an invitation or an opportunity
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  to do something you can't do it every time but but you know if you're judicious about
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  what you do say yes to I think that'll help you to maintain some level of balance you
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  know work life as well as within your career path that you can stay focused on the things
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  that are really meaningful for your career progression.
• 27:09
  Well I wanted to ask you actually a little bit about work life balance specifically like
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  me you're a father with a handful of kids.
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  Five.
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  I've just got three but I think I'm done.
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  That's a good start.
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  My question for you though is how do you balance all that five kids plus being ASA president
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  taking all these projects on how do you how do you broach these things with your partner
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  how do you rush these things with your kids how how does it all work together and be balanced.
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  Yeah I'd like to say I've always done that perfectly but I really you know looking back
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  it it you know there were definitely a lot more of those responsibilities so I fell on
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  my wife Kathy I don't know if she's here I think she'll be here later but for those of
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  you know Kathy she's tireless and just really if it wasn't for her I wouldn't be able to
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  have committed all of the time and and attention that I have to ASA things.
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  But I think that some of the things that I've learned over the years is if you are somebody
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  who really strictly keeps to your outlook calendar or whatever you know for your appointments
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  schedule in time for I'm going to go see a play with my spouse or go to a movie or we're
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  just going to get out of town for a weekend or because if you don't do that then everything
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  else kind of just continues to encroach on that and nibble away at that time that you
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  know you could be spending with your significant other with your family.
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  So but yeah definitely having a supportive partner is hugely hugely important and that's
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  what's you know allowed me frankly to commit all the time that I have to OSU and ASA.
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  So start by marrying the right person.
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  Yes absolutely.
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  That should be easy to do.
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  Good luck to everyone.
• 29:18
  So in your view what are some of the key qualities that make an effective leader in the field
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  of anesthesiology if somebody is interested in leadership but they're trying to look inside
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  themselves to see if they have what it takes.
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  What are some of the things that people should either try to cultivate or look for in themselves
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  to be effective leaders within our field.
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  You know I think that a lot of the attributes to make a good anesthesiologist also make
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  a good leader.
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  You don't freak out when something goes wrong.
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  You know everybody else around you may be freaking out but you know a good anesthesiologist
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  is the you know the calm in the middle of the storm and is able to focus on what's the
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  priority what you know what do we need to do to get you know get this patient better
• 30:12
  and not be distracted by all of the other things that are there flying around around
• 30:18
  you.
• 30:19
  I think that that helps in leadership because you'll have all kinds of things that that
• 30:25
  will be coming in your email inbox or whatever and to be able to identify and prioritize
• 30:31
  here's here's what's really important here's what I have to deal with.
• 30:36
  I think as anesthesiologists we interact with many other medical specialties in particular
• 30:43
  now that we do so much out of the O.R. and I think that gives us helpful perspective
• 30:49
  and and I think recognition and buy in from other specialties that you know 20 years ago
• 30:58
  we wouldn't have necessarily had recognition from interventional radiology or gastroenterology
• 31:05
  or you know various other non-O.R. areas that we're present at now that I think also helps
• 31:12
  with things like being having a leadership role within your medical staff and things
• 31:17
  like that because you're not seen as just the person who's on the other side of the
• 31:21
  drape in the O.R. so I think that you know I think that it anesthesiologists are you
• 31:31
  know that we so you know we kind of self select for our specialty and I think people who come
• 31:36
  in the anesthesiology and also you're not typically somebody who well I have to make
• 31:42
  sure no matter what first thing that happens is I get credit for the good things that happen
• 31:47
  because as anesthesiologists you know we're typically the ones that are kind of the unsung
• 31:54
  heroes and I think that makes a good leader frankly when you're more focused on having
• 31:59
  a positive outcome then how does this you know how does this reflect positively on me
• 32:06
  and how can I spend this you know for my own glorification.
• 32:11
  That makes a lot of sense.
• 32:14
  Lastly I wonder if you can share sort of a memorable moment or maybe a turning point
• 32:18
  from your tenure as ASA president.
• 32:23
  Gosh I would say for me it was when you know going back to the safe haven thing presenting
• 32:34
  it to the March board of directors so ASA for those of you who don't know inside and
• 32:42
  out ASA governance structure like I do so we have 12 officers and then there's a board
• 32:47
  of directors and every state has a director so Bosom Abdomalik who's probably somewhere
• 32:53
  in here yes raising his hand he is Ohio's director to the ASA board of directors so
• 32:58
  there's 50 plus a few other entities that have a representation on the board of directors
• 33:04
  and they really set sort of the fiduciary and you know largely drive ASA policy and
• 33:13
  direction and so I presented to the March board requesting financial support from the
• 33:20
  board you know as I mentioned you know charitable foundation was offsetting a lot of that but
• 33:25
  ASA had to front you know the money for all the subscriptions for these pilot subscriptions
• 33:33
  which was not an insignificant amount of money and anytime you go to the board of directors
• 33:38
  who they their primary duty is fiduciary responsibility to the organization when you ask for money
• 33:46
  you know it's always a little bit unnerving as to how that'll be perceived because you
• 33:52
  know every organization has has you know its own financial challenges and priorities and
• 33:58
  so forth and this you know this was a new expenditure and person after person came up
• 34:06
  from you know at the board meeting saying how important this was and you know validated
• 34:16
  that that was the right thing to be doing so there wasn't just my pipe dream you know
• 34:22
  of I think this is important and nobody else in the room thinks it is so that to me that
• 34:28
  was a big turning point or big you know validation for the things that I had been focusing on
• 34:35
  around the wellness program.
• 34:38
  That's fantastic and we all appreciate you fighting that fight for us thank you.
• 34:44
  Lastly the title of our talk is style points and what I ask all of my guests on the podcast
• 34:50
  is what advice you have in terms of what your own personal style points or points of personal
• 34:57
  preference that you use whether it's in the operating room or in your leadership roles
• 35:01
  what are some of your personal style points that you like to use on a day to day basis?
• 35:07
  Yeah I think you have to be appropriately self confident you know before I was president
• 35:19
  for ASA I was speaker vice speaker and then speaker of the house of delegates and that's
• 35:23
  kind of a very early lesson as a parliamentarian is never let them see you sweat you know so
• 35:29
  I think you now you better have the stuff to back it up because if it's just you know
• 35:35
  I'm incredibly confident but I don't really have any knowledge to back that up that that
• 35:41
  usually doesn't go very well but you need to have this sort of air of I've got this
• 35:48
  and you know that tends to instill confidence and people feel like okay this is somebody
• 35:56
  that that I you know I'm comfortable having them you know lead the house of delegates
• 36:02
  or ASA or or the department or whatever so but I think you need to also maintain humility
• 36:10
  that you can't be an egomaniacal confident leader you have to be confident but you know
• 36:18
  keep keep your ear to the ground as far as what are the you know what are the things
• 36:22
  that that people are concerned about and is there some blind spot that I have so I think
• 36:28
  if you know if you can be perceived as approachable so if people feel like you're going down the
• 36:34
  wrong path I would like to know that before you go off the cliff so it's it's sort of
• 36:41
  a combination of I've got this but if if if you think there's things that I'm missing
• 36:47
  you know the people feel comfortable sharing that so that's that's that can be a challenge
• 36:54
  to get that perfectly but I think that that's that's what I try to do within my leadership
• 37:00
  style thank you so much for joining us up here I really appreciate it thank you and
• 37:06
  I appreciate the the opportunity to do this and if there is some financial gain that you
• 37:11
  know ultimately comes from this I'll I wanted to leave a couple minutes at the end
• 37:17
  if any of you had questions I've been asking Ron questions for quite a while now but if
• 37:23
  any of you have questions that you wanted to ask our president then please David will
• 37:27
  bring you the microphone thank you very much what a great talk Ron as my chair for 14 year
• 37:41
  I have to acknowledge you publicly for your academic support and every time the question
• 37:47
  to you Ron is what about the future of academic anesthesiology and how we see the ASA helping
• 37:54
  the speciality with all the difficulty we have financially yeah great question I you
• 38:01
  know that the future of academic anesthesiology certainly I I saw firsthand you know running
• 38:07
  an academic department the financial pressures that academic departments face and I don't
• 38:13
  think it's gotten better in the two years since I've been since I stepped down as chair
• 38:18
  but you know much of what ASA does is around being appropriately paid for our services
• 38:28
  and it's we certainly have not won that battle but I think that sometimes is perceived within
• 38:35
  the academic realm is well you're only talking about money and you're really not you're
• 38:41
  not not talking about research and science and but I feel like if you don't get the
• 38:48
  financial support for for these the care that we you know payment for the care that we provide
• 38:56
  and should rightfully be getting that since we don't get that then we have to ask for
• 39:01
  ever increasing support from hospital leadership and it just creates this dynamic where you
• 39:08
  know you're getting you know seven figure eight figure support from the hospital and
• 39:15
  then you have the audacity to say and can we also have a little bit more for research
• 39:23
  it really makes a challenging environment so I think that all the things that we're
• 39:27
  doing to advocate for better payment for our services that's also hugely important for
• 39:34
  academic departments and I think a lot of our academic departments get that but I think
• 39:38
  a lot of them see us a lot of them see ASA is just we're kind of we're kind of a trade
• 39:45
  union almost you know that we're we're only focused on the dollars when really the dollars
• 39:51
  are what dry you know no no no margin no mission as we all kind of know so so I think getting
• 39:59
  that you know continue to fight that fight and hopefully you know I think we have some
• 40:04
  initiatives in place that might help you know to get more appropriate payment for what we
• 40:09
  do I think will help tremendously with the with the academic mission because it's you
• 40:16
  know we're all seeing increased pressure of you're in an academic department but your
• 40:22
  expectations clinically are not that much different maybe no different from what it
• 40:28
  is in private practice and you're also then expected to be doing the things that an academic
• 40:34
  anesthesiologist should do around teaching and research and and you know other scholarly
• 40:39
  activity so so I think until we get better payment for our services I think that's going
• 40:47
  to continue to be a challenge and I think we have to do that first and then you know
• 40:54
  continue to focus on the academic mission but it's hard to really get to where we need
• 40:59
  to be without that.
• 41:01
  I think we have time for one more question before the business meeting.
• 41:03
  Sir I appreciate your time thanks for coming out and talking with us I'm a fairly new attending
• 41:09
  two years at a residency serving military obligation of it right Pat.
• 41:13
  Thank you for your service.
• 41:14
  Absolutely I'm kind of witnessing all this stuff academic private practice unfolding
• 41:18
  of anesthesia obviously the shortage and as quote-unquote the future you know generation
• 41:23
  unfortunately a lot of things still seem a bit concerning like you touched on reimbursement
• 41:28
  continues to go down stipends need to go up.
• 41:31
  I have been privy to at least some local changes in the anesthesia dynamic in Dayton which
• 41:38
  there's been a lot of case studies over the last couple years obviously published even
• 41:41
  with recent you know journal articles specifically private equity in anesthesia and I can tell
• 41:47
  you just from first-hand experience trying to get some continued experience like you
• 41:51
  do in residency outside of a military treatment facility forces you to kind of get to know
• 41:56
  the local area and so I've worked in private practice physician-owned hospital contracted
• 42:01
  groups I've also worked at some private equity backed groups that have taken the contract
• 42:06
  so to speak from you know a group that have been there 20 years and the difference is
• 42:11
  pretty striking to me to be honest with you.
• 42:14
  So if you have any time I know it's a big grab a hole there but just kind of talking
• 42:17
  on maybe the ASA's you know perception and what we can do to hopefully you know not let
• 42:22
  the physician entrepreneurship die as it as it appears to be doing currently.
• 42:27
  Yeah great question it's a huge issue and huge concern so ASA has so we have various
• 42:40
  resources for you know privately held groups of you know how to make your pitch if you
• 42:47
  will to the C-suite because I think a lot of instances where that you know private equity
• 42:54
  or whatever or some other large entity private equity backed or not has kind of displaced
• 43:00
  a privately held group not always but there's some instances where if the leadership of
• 43:05
  that group could have had a you know better equipped to have conversations with the C-suite
• 43:13
  and maybe correct some of the misconceptions that they have because I think there's a
• 43:16
  lot of hospital executives that have learned the hard way that we thought anesthesia was
• 43:22
  expensive before and now you know you're you've displaced this group that was there for decades
• 43:29
  and now you've got locums coming and going that are really charging way more than what
• 43:35
  you thought was too much before.
• 43:38
  So I think that's one thing and we've reassembled a group because of the changing market and
• 43:49
  how things are changing so rapidly and all the pressures that are coming to bear on groups
• 43:54
  of various sizes that to make sure we're giving the best possible toolkit to people to be
• 44:02
  able to continue to have those good conversations with their hospital leadership.
• 44:11
  You know private equity is a concern but I think it's also it's not correct to say that
• 44:15
  if private equity went away tomorrow all of our problems would be would be over.
• 44:21
  It's because of the gap between what we get paid and what it costs to provide that service
• 44:30
  you know that's what creates I think the challenging dynamic where then it puts increasing pressure
• 44:37
  on well this other group can do it cheaper but the group that's doing it cheaper are
• 44:44
  they providing the same quality and the same you know level of care that's being provided
• 44:51
  by the you know by the current current group.
• 44:54
  So you know it's a concern but it's not just private equity I would say and so I think
• 45:02
  as we get you know if we can do better with getting paid appropriately for what we do
• 45:10
  that's that's going to help with that and I think the for the private equity standpoint
• 45:17
  you know even if ASA marshaled all its forces and said we're going to get private equity
• 45:21
  out of anesthesia you know that's not something ASA has the ability to do.
• 45:27
  The Department of Justice and various other federal entities are I think you know looking
• 45:33
  at you know what are the what are the aspects of private equity investing that drive the
• 45:43
  quality of care in a negative direction that diverts money that should be going either
• 45:48
  to providers or or improving patient care that gets diverted to the you know the investors
• 45:57
  as opposed to staying within the health care realm so it's a complex issue but I think
• 46:04
  the biggest thing ASA can do is help to have resources for our members to be able to continue
• 46:10
  to demonstrate their value that they that they provide and I think as you know there's
• 46:15
  there's some examples of some really failed you know takeovers that as those are you know
• 46:26
  communicated amongst hospital executives hopefully the oh I'm going to go with the quick easy
• 46:33
  fix here and pay less for anesthesia services by using this other entity whatever it may
• 46:39
  be that they're going to recognize that it's maybe not quite such a simple fix as what
• 46:44
  it's portrayed as by whoever's approaching them for their with their pitch.
• 46:52
  Well I think we're about out of time and we need to move on to the business meeting but
• 46:56
  thank you so much for joining me I really appreciate it.
• 47:04
  That's it for this episode of style points.
• 47:07
  I'd like to sincerely thank Dr. Harder for joining me.
• 47:10
  Hopefully some of his answers were as inspirational to you as they were to me.
• 47:14
  If you liked this episode feel free to subscribe or leave us a rating or a review.
• 47:19
  That helps other people find the podcast too.
• 47:22
  For the first time at the OSA meeting someone I didn't know came up to me a medical student
• 47:27
  from Northwestern and said that he realized halfway through this lecture that I was the
• 47:31
  style points guy.
• 47:32
  That was pretty cool.
• 47:35
  Thanks again for listening and lastly take a deep breath open your eyes we're all done.