No matter how great a job we do at clinical care, research, and education, anesthesiology as a profession cannot survive without fair valuation and compensation for our work. In the same way, the American Society of Anesthesiologists (ASA) cannot survive without fiscal stability, a solid growth plan, and a value proposition that resonates with today’s anesthesiologists. My career centers on these realities – how to face them, analyze them, and chart a sound course into the future.
I know the importance of financial stewardship. As President of the California Society of Anesthesiologists in 2022-23, I led the effort to restore our in-person meetings and put our budget back in order after the havoc of COVID. At Stanford, I have managed a budget even larger than ASA’s, with responsibility for operations, personnel management, compensation, and incentives.
Nothing is less glamorous or exciting than Current Procedural Terminology (CPT) codes, yet without them we don’t get paid. Realizing that we didn’t have CPT codes for new fascial plane blocks, I worked to propose six new codes and shepherd them through the tortuous, three-year approval and valuation process. Just last January, we succeeded in getting two new codes for interventional pain procedures. It’s tedious, time-consuming, and anonymous work, but critical to anesthesiology’s financial future.
As Section Chair for Education and Research, I have directly overseen the editorial boards that produce valuable ASA educational products. As part of the team that updates the ASA Crosswalk and Relative Value Guide every year, I know how essential these coding and billing products are for anesthesiology practices and healthcare systems all over the country. These products need active promotion so our customers know that they cannot live and work without them, and we must keep working to develop new ones.
Difficult decisions lie ahead. Our debates at the ASA Board level can become tense as we try to trim expenses without sacrificing programs and activities that may be critical to ASA’s long-term success. As the chair of multiple scientific conferences, I know firsthand about the rising costs of hosting live meetings. We need creative ideas, and we need growth. I will bring my experience and perspective to future initiatives focused on new sources of non-dues revenue for ASA, the promotion of the ASA brand, and the active recruitment of new members who will come to recognize the value and community provided by ASA.
As a researcher, I understand the need for innovation to advance science and clinical care, and the critical need to support advocacy efforts so that grant sources don’t continue to dry up. I have represented ASA and our members in many governmental and regulatory settings where I have been your voice, and I want to continue speaking and acting on your behalf.
I ask for the honor of your support and your vote as ASA’s next Assistant Treasurer.
At the first in-person House of Delegates (HOD) session since 2019, I became President of the California Society of Anesthesiologists (CSA), the first Filipino-American to do so. This could have only happened because of the incredible mentors and sponsors that I have been fortunate enough to have in my life.
Over the course of the HOD weekend in June, we held a fundraising luncheon for the CSA Foundation, listened to project presentations from the first cohort of our CSA-UC Irvine Leadership in Healthcare Management Program launched by Drs. Phillip Richardson and Ron Pearl, were treated to a special guest lecture by Sasha Strauss on how to communicate as leaders and demonstrate value, and I provided an educational session on using social media for advocacy. We hosted Dr. Robert Wailes, President of the California Medical Association (CMA), for an update on the Medical Injury Compensation Reform Act (MICRA) since passage of AB 35 (MICRA Modernization). For more information, see Dr. Wailes’ summary.
During the HOD session, I outlined my leadership priorities for this year: expanding public-facing and internal member communications; continuing leadership development; planning the CSA’s 75th anniversary (diamond jubilee); and promoting wellbeing and professional fulfillment within the CSA membership. I discussed the challenges facing anesthesiology and the importance of recruiting and retaining members. I summarized the value proposition as “Community, Solidarity, and Advocacy,” which also happen to have the acronym “C-S-A.”
Receiving the gavel from Dr. Ron Pearl, Immediate Past President of CSA and my biggest mentor and sponsorSpecial guest speaker Sasha Strauss
We followed HOD with our first Board of Directors (BOD) meeting of the governance year. We welcomed new Directors, appointed the CSA delegations to the American Society of Anesthesiologists (ASA) and CMA, and approved committee appointments for this governance year including an expanded Committee on Professional and Public Communication (CPPC). This new CPPC chaired by Dr. Emily Methangkool and staffed by Kate Peyser, and in partnership with Alison MacLeod and Lisa Yarbrough at KP Public Affairs, will be interfacing will all major committees, divisions, and task forces as well as the CSA Foundation to actively promote the great work by CSA members and advance the recognition, social standing, and influence of anesthesiologists.
Over the summer, I was Visiting Professor at the University of Michigan, hosted by Dr. Chad Brummett, and then had the privilege of participating in the American Medical Association (AMA) annual meeting as an ASA delegate to the AMA HOD. In this role, I was able to cast my vote for Dr. Jesse Ehrenfeld and witness him become the first anesthesiologist President-Elect of the AMA!
With Drs. Chad Brummett and Mark Bicket at the University of Michigan stadiumWith President-Elect of the AMA, Dr. Jesse Ehrenfeld
My family and I visited Greece for the first time as I participated as a guest speaker at the European Society of Regional Anaesthesia and Pain Therapy (ESRA) congress in Thessaloniki, and I also welcomed attendees to my first CSA educational event as President: the 2022 CSA Summer Anesthesia Conference. This meeting was chaired by Dr. Brendan Carvalho and featured a superstar all-women expert panel of dynamic speakers: Drs. Dalia Banks, Sapna Kudchadkar, Alana Flexman, BobbieJean Sweitzer, Romy Yun, and Elizabeth Ozery. All week, attendees and speakers engaged in conversations related to the practice of anesthesiology, caught up with old friends, and made new connections within the meeting room and around the resort. It was an amazing week of learning and family time and reinforced the value of CSA and its educational events in fostering community.
With friends and fellow ESRA invited speakers (Drs. Amit Pawa, Steve Coppens, Lloyd Turbitt, and Clara Lobo)CSA Summer Conference invited speakers (Drs. Sapna Kudchadkar, Alana Flexman, BobbieJean Sweitzer, Elizabeth Ozery, and Romy Yun), meeting Chair Dr. Brendan Carvalho, and special guests (Drs. Randy Clark, Joy Hawkins, and Morne Wolmarans)
Before leaving Hawaii, I participated in a face-to-face meeting of the Hawaii Safer Care initiative, part of the Improving Surgical Care and Recovery collaborative supported by the Agency for Healthcare Quality and Research, and led by Dr. Della Lin, Senior Fellow in Patient Safety Leadership with the Estes Park Institute and is an inaugural National Patient Safety Foundation/Health Forums Patient Safety Leadership Fellow. Dr. Lin invited me to participate as a virtual coach during the pandemic last year and work with improvement teams focused on implementing multimodal pain management for surgical patients, so this was my first time meeting the group in person. For this meeting, teams from three statewide health systems within Hawaii reported out the results of their projects. The leadership and collaboration among the multidisciplinary teams to implement change despite the challenges of variable resource availability, staffing, and inter-island coordination could serve as a model to inspire our statewide efforts within CSA.
What do we have on deck for CSA?
At the time of this report, we are receiving applications for the next CSA-UC Irvine Leadership in Healthcare Management Program cohort. Anyone interested can sign up here. We have appointed the task forces to work on revamping the CSA website and planning activities for the 75th anniversary, including a family-friendly reception at the Annual Meeting in San Diego (April 27-30, 2023) that will be chaired by Dr. Christina Menor. Stay up to date with CSA events through our online calendar. Then in October, our CSA delegation heads to New Orleans for the ASA annual meeting, and CSA members will actively participate in educational programming, committee deliberations, and governance activities. CSA will host a member reception during the conference, and our delegates will stand proudly when CSA’s very own Dr. Michael Champeau takes over as President of the ASA at the conclusion of the Wednesday ASA HOD session!
Edward R. Mariano, MD, MAS, FASA, FASRA is a physician specializing in anesthesiology, professor, husband, and father working to improve pain control, outcomes, and the overall experience for patients having surgery
