Editor’s Note: Barbara Baldwin has served the CSA with distinction as Executive Director and CEO from 1998-2012 and is retiring this month. It has been my privilege to work with her for all of those years, as I moved up in CSA leadership. She has been a superb resource and mentor for many of us in leadership, as the CSA and we faced those challenges described in her article and many others over the past fourteen years.
I became the CSA’s Executive Director in June 1998, and my first Executive Director’s column appeared in the September-October 1998 issue of the CSA Bulletin. In that column, entitled First Impressions, I described my first few months on the job as the new ED. As I prepare to retire from the CSA on June 15, I thought it fitting to review that column and reflect on how the issues and the CSA have changed over the years.
Back in 1998, the hot national issue was the possibility that CMS (then HCFA) might publish regulations that removed the physician supervision requirement for nurse anesthetists treating Medicare patients. At that year’s ASA Legislative Conference, physician leaders were optimistic that they would persuade federal regulators to at least postpone publishing the rules. While attending the Legislative Conference, back in California a public relations bomb went off by way of an LA Times article claiming some anesthesiologists were requiring cash prepayments for labor epidurals for Medi-Cal patients.
One of my first impressions was that this job would never be boring and after 14 years, it still holds true.
While the ASA was not successful in derailing the removal of the physician supervision requirement, the rule was moderated by then President Bush’s ruling that only states on an individual basis could opt out of the requirement after meeting criteria set forth in the rule. Governor Schwarzenegger’s opt out in 2009 brought the issue home. Since that time, the CSA and CMA, with the help of the ASA, AMA and other stakeholders have challenged the legality of the opt-out in the courts. At this time, the CSA and CMA’s petition for the state supreme court to review the case is pending, with a decision expected by the end of June.
In regard to the Medi-Cal epidural nightmare, some good came of it with better education of anesthesiologists on using the correct CPT codes for labor analgesia. In addition, a grass-roots coalition effort resulted in better payments (formerly, miserably low) for epidurals for Medi-Cal patients.
The last paragraphs of my introductory article discussed the CSA as a professional organization and are relevant to this day. One of my statements described the activities that would enable the CSA to be a successful organization.
“These include maintaining high quality continuing medical education, developing policy for new and changing issues, being proactive in our approach to socioeconomic problems facing anesthesiologists, and keeping the membership up-to-date on topics that affect their practices. We also must wisely use the constantly changing technology, information and communication abilities available to us.”
The ingredients to success include, “dedicated, involved leadership; interested younger members; committed, enthusiastic staff; a well-deserved reputation for excellence; and adequate resources (currently) to secure a place at the negotiating tables and the legislature, with state administration, in CMA, and at the national level in ASA and AMA.”
The elements and ingredients for success have stood the test of time. One of the primary tasks, “to wisely use changing technology, information and communication abilities,” required that the CSA operations transition from a “mom and pop shop” to a business model. This involved staff changes so that employees had needed skills and the ability to adapt to changing methods and demands. It also required significant and ongoing investment in the CSA infrastructure including the database and website. They are not one-time activities, but require continuous review and modification to meet evolving needs.
While I will remember dozens of issues and activities from the past 14 years, the memories that will last are about the people I worked with in many different capacities. From the CSA physician leaders who devote countless hours to shaping the CSA’s future; to the volunteer committee members, delegates and others who contribute time to advance key functions of the CSA like continuing medical education, legislative advocacy, communications, and financial oversight and guidance; hundreds have impacted the CSA in positive ways. Over the years, a few have also become friends.
Outside of the CSA, I have had the pleasure of working with ASA staff and my counterparts in state component societies where friendships developed as we worked together on common issues. We have all learned from each other and brought new information and perspectives to our jobs. Working with the CMA and state specialty societies has built upon many existing relationships in new capacities, with some friendships extending 30 years. I have known Bill Barnaby Sr. and Jr. for about 25 years and enjoyed working with them on new and recurring issues. I will always be impressed with their commitment to the medical profession and tireless work on physicians’ behalf. Working with CSA legal counsel Dave Willett and Phillip Goldberg has been educational and allowed me to see how nuances of the law balance the scales in favor of or against the good guys. They almost make me wish I had gone to law school.
The people I work with most closely on a daily basis, the CSA staff, are special people who will remain in my heart forever. They are responsible professionals who take pride in their work. When I read about employers’ negative experiences with young workers whose work ethics are lacking and sense of entitlement is blatant, I thank my lucky stars that the three CSA staff under age thirty are a huge exception, showing maturity and commitment. The staff over age thirty are seasoned professionals with expertise that takes years to acquire. They not only manage big areas of responsibility, they also mentor the support staff. Taken together, this is the best staff the CSA has ever had and are the makings of an exceptional staff team.
As I end my tenure, I wish all the best to the members of the CSA and the organization as a whole. The structure and delivery of health care is changing at an accelerated pace and unintended consequences of decisions made by the government, regulatory bodies and payors are inevitable. Professional organizations are a critical element to ensuring that decisions based on pure economics and faulty data are not adopted and physician/patient relationships and patient safety are given equal consideration. As a future Medicare beneficiary, I hope I will remain healthy and never need to be hospitalized. If I ever do need surgery or some other procedure requiring anesthesia, I plan to have an anesthesiologist care for me.