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spine, how often is awake fiber-optic intubation the
only reasonable alternative? Consider the patient's
point of view.
When we are consciously kind to our patients, we
feel better about ourselves as physicians and human
beings. Understand the science behind care protocols,
but never be afraid to individualize the care of the
patient in front of us.

My Top 3 Predictions
Here is what I see in my crystal ball: Those of you
who are in practice 20 or 30 years from now will have
a chance to see how right or wrong these optimistic,
best-case predictions turn out to be.
The training of anesthesiologists will break the mold
of today's iron-fisted control by the Accreditation
Council for Graduate Medical Education, Residency
Review Committee, American Board of Anesthesiology
and match system.
We'll no longer insist that every program train
every resident with exactly the same arbitrary
requirements. Academic residency and fellowship
programs will develop different tracks and
specialize along different lines. Some will focus on
scientific research, some on the economics and
operational management of health care, and others
on the clinical management of patients and care
teams. Cross-training with other specialties will
expand, and anesthesiology's influence will expand
accordingly.
You'll never hear the question, " But how will we get
paid for it? "
If a clinical service needs to be delivered,
anesthesiologists will figure out how to do it
safely and efficiently, without being hobbled by
fee-for-service constraints. New care models will
involve sedation nurses, ICU nurses, pharmacists

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and other staffers-in addition to anesthesiologist
assistants and nurse anesthetists-under the
direction of anesthesiologists across every episode
of care that includes an interventional procedure.
The current rigid supervision ratios and definitions
will no longer apply. There's no point in disparaging
" zone " models of OR coverage. Think of them as
comparable to how ICUs operate.
Technology will redefine delivery of care
Operating suites will have command centers where
multiple rooms can be viewed and monitored
simultaneously. Anesthesiologists will no
longer spend disproportionate amounts of time
performing nursing and pharmacy tasks: injecting
drugs into IV lines or mixing antibiotics. Better
drug delivery systems, with feedback loops and
decision support, will replace minute-to-minute
manual fine-tuning. As we work smarter, the
desires of upcoming generations for predictable
schedules and career satisfaction can be fulfilled.
If we face the future squarely and make changes now
that set our specialty up for success, we can bring joy
back to the practice of anesthesiology. The alternative
isn't pretty.

Editor's Note: An earlier version of this article
was published in the October 2020 issue
of Anesthesiology News.



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