A future that doesn’t exist?

  • Cole, Daniel, MD
| Sep 02, 2013

Editors note: Dr. Daniel Cole, a Past President of the CSA, is running unopposed for First Vice-President of the ASA. The First Vice-President of the ASA is on track to become the ASA President in two years. Dr. Cole served as CSA President in 2001-2002 and is a life member of the CSA. He subsequently relocated to Arizona and is currently Chair of the Department of Anesthesiology at the Mayo Clinic Arizona. The following is an edited version of his recent speech to the ASA Board of Directors about his candidacy for ASA office.

In the summer 2013 issue of the CSA Bulletin, Dr. Karen Sibert wrote a feature article entitled “Vinyl Records, Kodachrome Film, and the Future of Anesthesiology.” Dr. Sibert posed the question: Are we training residents for a future that doesn’t exist?

Wait. Are we indeed headed for a future that doesn’t include anesthesiology as we know it? Dr. Sibert’s question should strike at the very soul of our profession. And it has. So the ASA should not only consider Dr. Sibert’s question, but also take up the responsibility to develop a winning strategy to prepare for a positive future for anesthesiologists.

Our strategy emphasizes differentiation with three imperatives:

  1. Primacy of the patient-physician relationship
  2. Profound brand building
  3. Partnering with our stakeholders to provide unparalleled value

The strategy adopts a “play to win” attitude by addressing three questions.


There is no doubt that health care in this country is changing. Driven by disruptive public policy, medicine is transitioning to a value-based system with alternative payment models. We as anesthesiologists must be proactive — proactive in defining our relevance where value is created over the entire cycle of care of a patient’s condition.

With change, comes opportunity. Enhanced Perioperative Medicine, or the Surgical Home, is a framework of activities that increases our relevance by positioning anesthesiologists to own the continuum of care in a new way. Clearly, one size will not fit all. Enhanced Perioperative Medicine gives us an alternative with flexibility — flexibility to add selected activities that strategically complement what we are already doing. It empowers us with capabilities that provide “best fit” at the local level, thereby increasing our relevance in this changing landscape.

Preliminary evidence documents a decrease in mortality of over 50% for surgical home patients. Every day, over 500 patients die in American hospitals following a surgical procedure. We have an amazing record of quality and safety, but our work is not done. Imagine our relevance if we seize this opportunity to position anesthesiologists to cut surgical mortality in half.


Advocacy is critical to differentiation. Advocacy encompasses communicating our agenda in a manner that resonates with those who matter most, patients, other physicians, hospital administrators, legislators and regulators. It’s about closing the internal to external gap — about being at the table when decisions are made, and compelling “the decision.” Our agenda will live or die, depending upon our commitment to develop an arsenal of advocacy strategies that make our voices heard.

Let me touch on one gap that must close. Time and time again, survey data confirms that the public is adamant about physician involvement in their anesthetic care. However, an unacceptable proportion of the public is not aware that anesthesiologists are physicians at all, let alone that we are specialist physicians who are essential to safety and high quality health care.

This narrative must change! The knowledge that anesthesiologists are physicians with extensive training must be clear and pervasive. The question “Who is making my life and death decisions” must be forefront in the minds of our patients.

Let me relate a recent pre-operative experience that illuminates the point clearly. My patient was an elderly, ex-FBI agent who was literally suffocating from a lung mass. He could only speak a couple of words before he would gasp for air. Although our time was short, we had developed a deep and rich bond. As we concluded our conversation, in a moment that seemed to last forever, we locked eyes and he grasped my hand. In what felt like a phrase as powerful as his dying breath, he said, “I’m in your hands.”

I’m in your hands. Those four words are a powerful differentiator.


Anesthesiologists provide what every patient deserves:  the safest and highest quality medical care. Our aspiration should be absolutely clear — anesthesiologists will be fundamental to the future medical care of every patient. Patients deserve no less.

When it comes to fulfilling this aspiration we must — we must aggressively — push our agenda to the forefront of conversations, so we are heard. Anywhere. Every time.

Friends and colleagues, it has been an honor to have had this opportunity to discuss the future with you. Leadership counts, and it is with great humility that I ask for your support as we work together to secure the future of our specialty and fulfill our aspirations.

We are truly at a transformative moment and we — the ASA — must devote all of our energies and resources to the fulfillment of the aspiration that anesthesiologists will be core to the future of the highest quality and safest medical care that every patient deserves.

Let us never forget, that tomorrow belongs to those who prepare for it today. Let’s prepare, and we will create our future.

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