The Medical Brief
Conversations with today's most powerful medical industry professionals and leaders.
Join Dr. Brian Schmutzler, Dr. Ankit Patel, Dr. Jeremy Heffner & Host Vahid Sadrzadeh for The Medical Brief Podcast powered by SurgeOn.
The Medical Brief
Leading Through Crisis: From COVID to GLP-1s
On this episode of The Medical Brief Podcast, the guys are joined by Dr. Ron Harder.
Dr. Harder, the outgoing president of the American Society of Anesthesiologists (ASA), shares his journey through leadership and discusses critical challenges facing the specialty today.
Dr. Ron Harder
https://wexnermedical.osu.edu/find-a-doctor/ronald-harter-md-3384
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This is the Medical Brief powered by Sir John. I'm your host, Fahid Sadrazadeh, alongside Dr Brian Schmutzler and Dr Ankit Patel, and joining us remotely here is Dr Ron Harder, who is the outgoing president of the ASA and just finished his term this past October. Dr Harder, thanks so much for making time and being with us here today.
Speaker 2:It's my pleasure to be here with you this evening. I'll let.
Speaker 1:Dr Patel, kind of introduce you and kind of get our conversation started here.
Speaker 4:Yeah. So, dr Harder, again, thank you for joining us tonight. I think what we do here is we interview key healthcare leaders around the US. Thought leaders, innovators, key professionals and clearly you have led one of the largest organizations for physicians the past year. You are at the Ohio State University, who is coming off of a very big win.
Speaker 1:Man. Sorry, brian, geez, why are you going to do that? The dagger man, it's so fresh.
Speaker 4:The dagger right to the heart.
Speaker 2:I like the way the call is going so far.
Speaker 1:You got two diehard Notre Dame fans on the other side of this. Call For context.
Speaker 3:I'm a Notre Dame grad and he used to work there.
Speaker 1:Yeah, still works there. Yeah, we were both at the game the other night. He does a pregame show for the team.
Speaker 4:So yeah, they are closely linked. So, guys, I'm sorry I had to do it.
Speaker 1:Oh, thanks for that. Anyway, you can lead the rest of the conversation. We're gone.
Speaker 4:We're both out frying in our milk. Dr Harder, how we do this? We kind of want to get to know you as a person. Obviously, everyone holds a position, but we want to get to know you as a person. Tell us your story. How did you get to the ranks of becoming our ASA president? And then we'll kind of go from there.
Speaker 2:Yeah, great, great question. I started my involvement with ASA when I was a resident there. It was only about in its third or fourth year of existence that there was a resident component of the ASA and there were national officers for that, and that's. That component continues today. That component continues today and I was elected to one of those national offices for ASA. So that really gave me a great launch into understanding the organization.
Speaker 2:And the more that I learned about ASA, the more I wanted to be more engaged and more involved, because I just saw so many really dedicated and committed anesthesiologists that were so passionate about assuring that we provide the best care for our patients on, you know, and that takes multiple forms, you know education, science, advocacy, and so having that opportunity so early in my career sent me on a path where I could then see sort of the next steps in the progression.
Speaker 2:I was in our House of Delegates for several years and those are anesthesiologists from all over the country that determine the policies for ASA. Then, subsequently, I was on the Board of of directors for ASA for a few years. There's one director and one alternate director from each state that serves on our board and then I was elected to office. I was vice speaker of our House of Delegates and then speaker of our House of Delegates, speaker of our House of Delegates and then speaker of our House of Delegates. And so then, as I was sort of getting to the end of my shelf life on serving, as in those roles I ran for first vice president, which then that ascends to the president elect, then the president and now the immediate past president.
Speaker 4:It's a long process, but certainly it's a time commitment of time and energy. We appreciate you doing all that because a lot of good work that you've done.
Speaker 2:Well, it's been a wonderful experience and I just can't say enough great things about ASA as an organization and so many of our members who you know. I certainly yes, I will acknowledge I have committed a lot of my time for ASA but there are so many colleagues who you know are doing similar levels of commitment and maybe don't get the opportunity to be on a podcast and be acknowledged for what they're doing. So I definitely I recognize very well that ASA wouldn't be the organization it is if it weren't for the terrific passion and hard work that so many of our colleagues do on behalf of our specialty.
Speaker 1:Well, Dr Harder, we asked Dr Arnold this question as well, kind of want to get your take on it, kind of to start the dialogue here. So we want to look ahead, but in order to look ahead, we got to go back and you know, the last couple of years has created challenges for a lot of specialties and a lot of providers. But can you talk about some of the challenges that you faced as an organization dating back to the start of COVID and some of the challenges as a result that you're facing, maybe even going into 2025?
Speaker 2:Sure, well, you know, covid was a challenge unlike any other and I think you know any of us who have been certainly on the healthcare provider side of it recognize that we didn't really have a playbook to follow. We really had to figure things out as we went along. It was really uncharted and I guess there was some consolation in the fact that we were all figuring it out together. I was at that point I was speaker still of our House of Delegates, so I was one of the ASA officers, so I was very involved in those conversations. But Mary Dale Peterson was our president at that time and she has been an executive leader in her health system for years and so she had managed through their hospital system, with she's in Texas and so tropical storms, hurricanes, you know various challenges certainly nothing on the scale of COVID, but it really. She was as well prepared as anybody could have been coming into the COVID pandemic and she very quickly assembled a group of experts and leaders within the organization because we had to almost daily come up with new guidance and recommendations on how to manage things when we didn't have enough ventilators perhaps. So we didn't have enough ventilators perhaps, and we didn't have enough N95, certainly for quite a while, and just all of the daily challenges that we were facing and to try and give as good of advice as we could to our members through that. I think that now that we're sort of in the realm of COVID still around, but we, I think, have a large tent involving as many people as you can so that you can really make sure that you don't have blind spots and that you're really covering things as best you can, and I think we've, you know, learned some good skills as a result of that, learned some good skills as a result of that.
Speaker 2:One example that was certainly not nearly of the magnitude of COVID, and hopefully nothing we have to deal with will ever be of that magnitude again, was the GLP-1 agonist issue. We were hearing anecdotally from our members that they would have patients on GLP-1s. They had followed standard fasting guidelines but they would vomit and it was clearly undigested food particulate matter. That you know, is very concerning for a patient who's sedated or under general anesthetic that can't protect their airway reflexes and that could potentially be a serious, if not fatal, pulmonary aspiration event, if not fatal pulmonary aspiration event. So we, on a smaller scale but similar process, as we did with COVID. We convened a group of experts within our specialty on NPO guidelines, fasting, et cetera. We had just recently updated our just normal fasting guidelines. So we had a group already teed up with expertise and real knowledge of the literature and the science behind, you know, fasting guidelines and we came out with some recommendations.
Speaker 2:We have since made some revisions to that, which is we knew from the start that we didn't have the final definitive answer on that because there wasn't much in the way of hard data, prospective, randomized controlled trials. We were going with anecdote and case reports, which is not ideal from a scientific standpoint. But we felt that we would benefit our members and our patients to increase awareness that for patients who are taking and the growing number of patients who are taking those medications, that delaying the time between when they take their last dose and then when they have anesthetic, that that probably has some benefit. And we're now finding that perhaps a longer fasting period, perhaps having clear liquids as opposed to solids for an interval of 24 hours or so prior to the surgery, those things seem to be associated with having more likely to have non-particulate, you know not significant amount of gastric volumes. So the very long answer to your question. I think that's the best example that comes to mind where the lessons learned from COVID we were able to pivot, adapt that to the situation at hand.
Speaker 2:I would say, historically ASA would not have said anything about GLP-1s until there was conclusive about GLP-1s, until there was conclusive, definitive, ironclad evidence. But I think that that would have been a disservice. I think in large part because of ASA coming out with the guidance, we got a tremendous amount of media attention, not only within the medical press but within the lay press, that now it's very, very common when I have a patient who's on GLP-1 agonist they're very aware, their primary care doc is aware, their family members are aware that you know that you need to hold off on your GLP-1 agonist before you are going to go have surgery. I think had we just sat on the sidelines until we had solid evidence, there would have been a lot more patients potentially that could have been harmed because they would have just been going ahead assuming that they had followed standard fasting guidelines, but it just wouldn't have been sufficient.
Speaker 4:You know, one of the things we learned from COVID also was that this notion or this idea that you're sharing information with what information you have. So you know healthcare providers all we can do is instruct patients with the only information we know. Now that information we know can change and it evolves, and I think that may not have been the case 10 years ago. Just like you said, we would have waited for ironclad data. Now I think it's a little bit more acceptable to say here's what we're recommending, based on what we know, and I think that can change, just like as Brian and I roll out those guidelines to our hospital systems, we change it every year because things change every year.
Speaker 3:So I think that's one of the things we've learned, and I think you know that a lot. I'd love to hear your personal experience in the operating room, both with COVID when that first started, because you're still a practicing anesthesiologist and so what was your experience with COVID and then what has your experience been with the GLP-1s, and maybe we even compare notes here on the show.
Speaker 2:Yeah, yeah, absolutely. So I was chair of the department at the Ohio State University. I don't know if you're familiar with that.
Speaker 1:Never heard of the university.
Speaker 3:Little school in Columbus or something. Little school in.
Speaker 2:Columbus or something, and so I was chair of the department through the first couple of years of COVID. I stepped away from the chair role as I was moving into the president-elect role for ASA because of the significant time commitment that that job requires and, as I said at the time, I can only do one 24-hour-a-day job, not two and so. But during the initial couple years of COVID I was chair of the department and so I did practice clinically and I made a point as much as I could to be, you know, be there alongside all the other professionals in our department so that I wasn't leading from the rear and, you know, telling everybody what to do while sitting safely at home or in my office. But that was much like the ASA having to contend with what's the crisis of the day or of the hour. Even that was a very challenging time. You know, it's sort of a microcosm, I guess, of ASA. I tried my best to get input from a lot of folks, but there also needed to be, I felt, sort of a single source of truth. So I tried to shepherd the latest recommendations on N95s and how many times you could use an N95 and how to, you know, don and doff your gloves and your gowns and all of the things that we were all learning at that time, but it was. I've never had a more stressful time, you know, leading the department because it was just so unprecedented and it was.
Speaker 2:What was unique and particularly difficult as a leader of the department is I was in a position where I had to ask people in our department to really put themselves in harm's way. But we all do this to take care of patients and normally there's not a significant amount of personal risk that we're undertaking to do that. But in this situation there was, and certainly until we had vaccines and especially until we had adequate personal protective equipment. It was a very challenging time. Thankfully, none of our providers you know were, you know incurred any serious infections and you know had any ill effects to my knowledge, you know, during that time. But that was my huge fear was that somebody that you know that we were asking to take care of patients would get COVID and subsequently, you know, get extremely ill or even die. So that was a particularly challenging time.
Speaker 2:Frankly, I relished to some degree the opportunity to work clinically because surgical volumes were, you know, dramatically lower during that time. So I didn't really I wouldn't have needed to be in the OR at all during that time, but again I felt like it was important to be there and it gave me a little bit of a sense of I'm kind of in there with everyone else and I'm seeing what they're seeing and experiencing what they're experiencing. We had a 24-7 airway team. In normal times there's people who are available that can respond to codes and innovations, but it wasn't necessarily that's the only thing they're doing. But again, with the limited PPE and the time required, at least initially, to figure out how to get your gown and your gloves on and everything and your N95 and all those things, we felt like it was best to have just a dedicated team. And so I took a couple of turns, you know, on that team myself, because I I I didn't want to again be perceived that I was asking people to do things that I would not be willing to do myself.
Speaker 3:Were you using video laryngoscopes for that when you were doing the innovation team?
Speaker 2:We, we, we were as much as possible, but that was another one of those, you know day by day crises because the McGrath video laryngoscope disposable blades.
Speaker 2:There were various times where we had one size but not another, or we didn't have any. You know any, you know stockpile of any of them and so I'm asking people to be judicious with using those. But at the same time, you know everybody understandably wanted to have the video laryngoscope because it gave you a little more distance between your face and the patient's airway. You know, especially with no PPE at that point, and what about the GLP-1s?
Speaker 3:What's been your experience with those?
Speaker 2:Yeah, that's a good question. It's. You know, I was down in endoscopy today and so that just it's a large volume of patients. But those patients, fair amount of them, tend to be on on GLP-1 for either, you know, weight control or diabetes or both, and it at first it was a challenge just because patients, you know ASA had put this guidance out but it hadn't necessarily gotten spread to patients yet. Some of them were aware of it and some of the gastroenterologists or other referring physicians may not have been aware of it, and so you'd be faced with this here's a patient who's come in, maybe done a bowel prep, they're on a GLP-1 agonist and and, but they took you know, they took their Ozempic three days ago.
Speaker 2:So then what do you do? So you know, we recognized again, the science wasn't perfect and what I did, and what I think a lot of people did, was to look at the individual patient. If they said, oh, I'm full, I'm bloated, I feel a little nauseated, those are patients that maybe you'd need to be more thoughtful about, whether you go ahead with an elective procedure or not, or if there is urgency that you need to do it, then that's maybe a rapid sequence induction. But you know, if they maybe didn't quite adhere to the guidelines but they tell you they're very hungry, like you would expect a FACET patient to be, and not having any GI symptoms, I'd be a little more inclined to go ahead and treat them like I normally would, certainly a little more likely to go ahead and intubate somebody that I might, you know, do an LMA for, for example. You know, I think we probably all push the line a little bit more towards cuffed endotracheal tube and you know, even rapid sequence if there was a question about things.
Speaker 2:But I generally always try to do right by the patient and usually that is to try and get their procedure done. That they have. You know, in some cases they've driven two hours to come to the facility to get their surgery or their procedure. They fasted again. They may have had a bowel prep and to be rigid when the science wasn't particularly perfect. At that point I felt like there needed to be a little bit of flexibility on the application of that and I think that's, you know, talking to colleagues around the country, I think that's similar to what a lot of people have done.
Speaker 4:And I think, as the number of patients we see come across on those types of medications is just going to grow rapidly as it becomes over the counter, I personally have found good success with other providers who are receptive to that conversation. You know a lot of the surgeons or GI providers. You know. They know that this is here to stay, it's not going anywhere, and I think we share them the data and the flexibility that we have. You know we're learning along the way. I have not really found or encountered a lot of negative. You know feedback from the providers that don't cancel my case. Don't delay this patient's care, because I think you and the ASA have done it well where you've kind of step-wise into. Here's our recommendation. But there are a couple of caveats here. If they give you symptomology, then you can move forward or you can cancel. So I think there's a lot of built-in flexibility where I think we're trying to harbor good relationships with other providers. Brian, would you think that's the same with your experience?
Speaker 3:Yeah, I mean, I work with a lot of orthopedic surgeons so they always want to do their cases, but they've been more reasonable since all this stuff's come out and it's gotten more sort of mainstream right. You hear about Ozempic, you hear about some of these other GLP-1 medications. So yeah, I would agree with that for sure, dr.
Speaker 1:Harder working with Dr Arnold. You know what was it about passing the torch from year to year. That was important to you, that was important to the ASA, kind of as we look ahead now, you know what were those important topics or factors or discussions that went into passing the torch to him.
Speaker 2:Yeah, that's a good question, and one of the things that I came to appreciate pretty early on, even as first vice president, is those four offices the first vice president, president-elect president and immediate past president that comprises the executive committee for ASA. We have a weekly Zoom call, frequent emails back and forth and a fair number of ad hoc you know conversations and meetings that occur throughout the week and so it really gives you a very nice gradual runway from the between the immediate past president and president-elect year before your president in president elect year before you're president. That there's, um, there are some things that really only the president is involved with, just because a lot of those are the media type of things that they they want you to make a comment, you know, within the next hour type of thing, and you just don't have the luxury of of really bouncing that off of of people. But most of the big, weighty issues we've, you know we're all in the loop on those and we've been talking about, so it wasn't like you know. Here's the big book of secrets, don, and you know now you've got to figure out all the things that ASA has been doing, you know, over the last year.
Speaker 2:You know he had a very good idea and I think that every president has their areas that maybe they're more passionate about, maybe they have more expertise in and it feels more like that's in their lane and it's an area that they want to pursue.
Speaker 2:You know, don was treasurer of ASA, so he has a very good grasp of ASA's fiscal affairs as an organization.
Speaker 2:But he's also been chair of his group, mercy in St Louis, for I don't know how many years, but quite a while, and so he has a really terrific understanding of the practice management aspect of things. And so you know, I think that it's that is maybe more of a guide of what you're going to do in your presidency than anything the president who preceded you might tell you I certainly benefited from little nuggets here and there from past presidents of things that the best advice I got was identify one thing that you would like to do that is above and beyond the, just the blocking and tackling and all of the day-to-day things. You know ASA is a big organization. There's a lot that goes on, and just doing that can you know that's a that's a pretty big job. But you know, is there something that you can identify that at the end of the year, you can look back and say, yes, that's something I wanted to do and we were able to accomplish.
Speaker 3:What was that said, ron? Yeah, that was the exact same question I was going to ask. Yes, thank you.
Speaker 2:I was hoping you would ask me that.
Speaker 2:So I have been very interested in burnout and wellness. It's a huge issue. Covid made a bad situation worse for really every medical specialty and we've got some pretty compelling surveys that one of the committees within ASA some of the members of that committee did a survey of the burnout level and some other kind of job satisfaction type of question, surveyed our members at like. Literally they couldn't have picked a better time prior to the pandemic it was early March of 2020. So it was people were starting to hear about COVID, but it wasn't really impacting our jobs yet and we weren't being faced with it, so it was about as good of a pre-COVID snapshot as you could get. And then they followed it up a couple years later and clearly burnout, you know, had gotten significantly worse during COVID. And so I and you know we deal with workforce challenges et cetera. And so if we have people who are leaving the specialty or they're, you know, moving to other areas of medicine or they're just practicing less, you know, less of an FTE, all of those things then just further compound the workforce challenges that we have. And so if we're able to provide some resource for our members to help them with wellness, it's great, certainly for them individually, but it's also great for us as a specialty, to have people who are better equipped to handle the various, you know, really significant stresses that have always been there in our specialties, because, you know, we're dealing with patients' lives every day and that's not something that you know that is easily done and it definitely has a weight to it. And then the further challenges of COVID. It and then the further challenges of COVID. So we were able to implement during this past year that we now offer an online service of a subscription service to it's called Safe Haven, and there are some other medical specialties that and some state medical associations and so forth that also utilize those services, and so it's it provides for anyone who signs up for it they can have online counseling episodes, they can have coaching. Online counseling episodes. They can have coaching. They can have. There's a 24-7. You know, if you have just a real crisis in your life, at 2 am you can call that crisis line and have somebody that you can talk through that with. It's by being set up outside of your employer.
Speaker 2:There's a lot of maybe unfounded but still, I think, understandable concern that people have about using employee assistance programs. That is my boss going to find out about this? Is the ceo going to know who's who's needing counseling, etc. Am I going to need to report this when I go for recredentialing, etc? So, um, so this is. Asa doesn't even know who the people are. We know the numbers, but this entity they're the, you know that that manages this. They know the people who have subscribed, but we don't know that. So it gives a nice firewall, if you will, around the individual that they can get these services without any fear of what's my chairman going to say, what's my boss going to say.
Speaker 2:And we've to this point, we have over 200 anesthesiologists that have taken advantage of those services and we also get reports from Safe Haven as to, you know, do they just sign up and then, okay, I've checked that box and now, if I need it, I'll use it, but I probably won't need it. Check that box and now, if I need it, I'll use it, but I probably won't need it. That there is. The utilization is over 100%, meaning that on average, everybody has used that signed up, has used it at least once. Now there's obviously some people that have used it multiple times and you know of the various resources that are available, and there are, you know, undoubtedly some people that haven't used it.
Speaker 2:As we were going into this, I even commented that our goal shouldn't be, excuse me that 100% of the people who sign up use those resources. You could really view this as sort of wellness insurance or burnout insurance that if you need it, if you, you know who knows when you're going to have that crisis at 2 am that you're really struggling with and to know that you can, you know, pick up the phone and call. Maybe you never need to do that, but there's still value to the people to have that, you know, peace of mind and knowing that there's, that they have those resources available to them, even if they don't necessarily use them. But it looks like the uptake has been very good. So I think, even if you help a few members, then it's been totally worth the time and the effort and the investment that ASA has made into that program and I think that's you know. So that's something that I, you know, have a nice feeling of accomplishment to get, that have gotten that over the finish line during my presidency.
Speaker 4:Yeah, and that's so wonderful, especially because some of those things that you mentioned, you know, will my, my, my chairman find out, will the hospital know? Those are, unfortunately, things we all think through before we think about getting help, you know, and so it's, it's great that it's you know. You guys have thought through all that. So very nicely done for, for your, your pinnacle year. Yeah, done for your pinnacle year.
Speaker 1:Another topic that we kind of wanted to pick your brain about Dr Harder, along those lines of burnout, you know is the shortage of anesthesiologists, and we've talked about this extensively. Dr Schmutzler and I have talked about this in his podcast, and Dr Patel Certainly we have brought you into that discussion as well and we talked to anybody we can about this issue. Where do you kind of stand, personally and professionally on the short of anesthesiologists, how to bring in maybe more CRNAs and work with those specialties? In terms of where do we go, you know? What is the next step? What is the answer to the shortage of anesthesiologists? Because certainly the profession is very different than it was 30, 40 years ago.
Speaker 2:Yeah, Great question and this has been an issue that ASA has really devoted a lot of attention to. We've had two workforce summits where we convened a group of stakeholders surgeons, representatives from non-physician anesthesia providers so CRNA and certified AAs providers so CRNA and certified AAs, c-suite representatives, leaders in resident education for our specialty and people from large group practices, small group practices, medium group practices, academic departments and to really get our arms around. What are the challenges that we're facing? What are some? Are there some success stories? Are there some things that people have implemented that can be disseminated more broadly? So, to grossly oversimplify it, it really comes down to supply and demand, you know, and what can we do to increase the supply? But that you know we're talking. If you're talking about physician or non-physician providers, either one, that's not something that you can snap your fingers and tomorrow you'll have 20% more providers. The demand side I think there is opportunity there that some significant reduction or right-sizing of demand can occur. We've been specifically looking at the non-OR anesthesia or NORAH services in particular. Anybody you talk to in the anesthesia world will tell you that and I can say personally, when I started my career, it was really unusual that you'd have to do anesthetic outside of the OR and it required a lot of logistical preparation and everything, and it was definitely a one-off, unique type of circumstance. And now we're nearly half of all anesthetics are given in the non-OR setting, and so it's a testament to how skilled we are, what great care we provide, what a satisfier it is for patients and for the professionals that we work with the proceduralists, the surgeons you know that we, they know that they can't do much of what they do if it wasn't for us providing care to the patients. So it's wonderful that we've made those advances. But it's caused a huge increase in demand for our services and with that rapid growth there's been some probably less than ideal growth that's occurred.
Speaker 2:There are you know just from what I've either seen firsthand or has been shared with me where you might have a setting where you have a proceduralist who's got two procedure rooms. One is an anesthesia block and the other is they just give procedural sedation themselves and they may flip-flop between those rooms. So you've got an anesthesia team that's sitting idle for 45 minutes or an hour while they're doing their procedure next door. Rather than I'm going to fill my block, I'm going to be held to a certain level of utilization similar to how we run the ORs. Right, we wouldn't, you know, if surgical time is in demand, which it pretty much always is, you wouldn't let a surgeon have, you know, 40% utilization and just, and then, when they want another block, say sure, you can have it, and so.
Speaker 2:But there's a lot of challenges with getting your arms around the non-OR services, because they can literally be in the four corners of your medical center and to have a single line of sight onto all of those sites.
Speaker 2:Sometimes it doesn't communicate with your electronic medical records, so you're literally having to call people on the phone and see if they're done with their cases or how many they have left or if they're running on schedule.
Speaker 2:So it has some logistical challenges. And there are some things too, that when you have these new off sites there may not be a recovery area nearby, which then that's an efficiency but also a safety standpoint, if you're having to transport a freshly extubated patient halfway across the hospital to get them to your standard recovery room. So can you create some satellite recovery areas that then give you safety as well as efficiency, and so that doesn't happen organically. It needs somebody, and our strong advice is that should be an anesthesiologist who leads that and really manages it, just like it was a suite of ORs that you hold the proceduralist or whoever has those anesthesia blocks, that they've got to hit certain utilization levels and first case on time starts and turnovers and all the things that we have done pretty well in the ORs that we haven't always translated so well to the non-OR settings.
Speaker 3:We're seeing a lot of in Indiana because we're not a certificate of need state is expansion of surgery centers you know we've got particularly in the corners of the state because every state around us is a certificate of need state. Is expansion of surgery centers you know we've got particularly in the corners of the state because every state around us is certificate of need state and as well as office based anesthesia, which admittedly I was involved a little bit in helping making that safe in in conjunction with the ISA. So how do we address demand when not only are we talking about increased demand in the hospital itself but increased demand at ASCs, in offices, all that kind of stuff?
Speaker 2:Yeah, great, great question. And you know certainly we're not going to do it purely on optimizing the demand side. We need to train more physician and non-physician providers. I think one of the greatest opportunities for growth is with certified anesthesiologist assistants. They're now licensed in 20 states. For people who aren't familiar, they have really roughly the same training as a certified nurse anesthetist Prior to their master's program. It's a little bit of a different path but having worked with both of them, we've had AAs in Ohio for decades and we have many here at Ohio State and they really can bolster your non-physician workforce. But there's a lot of states that still don't have them licensed yet. So that as well as just adding more schools then, so that as states add licensure, they can, they have people that they can, they can hire, I think there's a lot of opportunity in that area.
Speaker 2:We're seeing pretty significant growth of nurse anesthetist programs as well. And then you know I think it's well known that for anesthesia residency positions we have never seen the kind of demand that we have and that we've had for the last few years for resident applicants, that the quantity as well as the quality of the candidates has. It's just stunning how you know the pool of candidates that we have and we've had a consistent growth in not logarithmic by any means and we've had a consistent growth in not logarithmic by any means, but we've had a consistent growth in our residency program numbers and the number of spots available in the match and every spot that we put out there is getting filled and there's a growing pool, frankly, of really good candidates who don't wind up matching, at least not their first time around in anesthesiology. And so that would suggest that you know we've got opportunity to continue to grow the programs we have as well as look for opportunities of are there settings where we could start some new programs, and some of that has occurred, that there are some more community-based, you know private practice-based residency programs. Now that gets, you know, somewhat out of the lane of ASA. That's really for the ACGME and the Residency Review Committee to assure that you don't start, you know allow a program to start, unless they meet the criteria for training, you know appropriately training anesthesiologists and that they maintain those standards. But there are some examples, I think, of some programs in recent years that have opened up and, by all accounts, are doing a good job with training anesthesiologists. So I think that's an opportunity that we need to continue to look for.
Speaker 2:What opportunities do we have? The demographics, you know, if you just look at the anesthesiologist numbers too, where there's a lot of us, myself included, that are in that 55 and above range, that you know our shelf life is getting a little bit limited, and if we don't really, you know, continue to replace the people that are going to be leaving the specialty in the years ahead, we're, you know, really going to be challenged. So I think there's, you know there's opportunity there. It's not a quick fix. If there's any, maybe glimmer of hope on that.
Speaker 2:The question we get asked all the time is how many are we short, both doctors and non-physician anesthesia providers?
Speaker 2:And there's no perfect barometer for that, but we, within our Center for Workforce Studies, within ASA, track the number of Gasworks postings, you know.
Speaker 2:So, gasworks being an online posting service that is certainly, I think, the biggest player in that space. It's again, it's not a perfect barometer, but it's probably not bad, and the number of postings had been going up pretty steadily since, really a few months after the pandemic got started and we started to see that return to surgical volume and where we really started to feel the pinch on providers. For the last couple months those numbers of postings have started to come down a little bit. So maybe we're turning the corner a little bit on that, but I think it's too soon to really declare victory on that and there's still a lot of positions available. And I don't know about all of you, but I think I got three texts today from different. You know that nobody that I've ever contacted or expressed interest in of hey would you like to do locums. You know at various places around. You know around the state or beyond, and so the demand clearly is there. But maybe we're starting to make some gains in that respect.
Speaker 3:I usually get those calls right as I'm trying to put a patient to sleep. That's usually when the phone starts ringing.
Speaker 2:Yes, yes, couldn't have been worse timing.
Speaker 4:No doubt they probably take into account. The life expectancy in the US is going to keep growing and that just means that the GI centers, the orthopedic centers, all those facilities will need more care than they anticipated five years ago. So I would imagine these conversations will still be ongoing. Brian and I did talk about the ACGME's role and how can smaller programs start in addition to the big programs like OSU. You know, take on an extra two or three residents per year, and I think that's probably what I would hope is the future where these numbers have to grow. It's just there's no way around it, and so that's my goal to piggyback off that. What is your goal for the future for the ASA, whether it's from members or from the US? What is your goal?
Speaker 2:Yeah, it may be hard to narrow that down to a single goal, but I would say, above and beyond everything else, to make sure that every patient who's getting anesthesia care in the US, every patient who's getting anesthesia care in the US, has an anesthesiologist who's either giving the anesthetic or is immediately involved in directing that anesthesia you know 24-7, whatever setting you know, whatever setting you're in.
Speaker 2:I think our patients deserve that. I don't think we'll get to a point where every anesthetic is going to be personally performed, but I feel very strongly. I did personal performance. I left OSU for an interval and I did personal performance of my own cases for five years. I think it's a wonderful model. You really have that direct patient care and I think we would do ourselves a disservice if we moved entirely away from personal performance. I'm not saying that it's easy with the challenges that we're facing with staffing, but I think we need to keep that in mind as well, that that is an excellent model of practice that we need to fight to continue to be able to deliver care in that model.
Speaker 3:So where do you go from here? You're past president now, so the cycle ends in October, right? Yeah, so that's always the question, right? Where does the president who's been the president go from there? So what's next for you?
Speaker 2:Well, for now I've really been enjoying having more time clinically because in my time as, because you know, in my time as chair, I would be maybe 30% or so clinical and then over the past couple of years, not much more than that, clinical with my ASA duties. And you know, since October I've been 80% or so clinical and I will say it's it's, it's been very enjoyable. So, you know, anesthesiology is a, is a lot, is a lot of fun and it's a great, great specialty. And I have enjoyed having more, you know, opportunity to interact with the patients and with the folks in the OR and so forth. So if that's what I continue to do, I'd be very happy doing that. So I don't have any grand, uh, grand plans at this point. Um, so we'll just, we'll just see what happens. But you know, as it, as it turns out, being an anesthesiologist is a, is a uh pretty good path.
Speaker 1:Would you do it again? Yeah, if, if, if you know what right Well you know if you would. You would you do it again if you had a choice?
Speaker 2:as a president, oh yeah.
Speaker 1:And anesthesia, anesthesia anesthesiologist?
Speaker 2:Yeah, absolutely yes to both. Yeah, it was a tremendous honor and it just was a great opportunity, so I would do that again in a heartbeat. I'm not going to come back and run again in four years, but it was a great experience. And, yes, certainly anesthesiology is a specialty. It's been wonderful and I've really just loved it and would do it again in a heartbeat.
Speaker 3:What's your favorite kind of case to do?
Speaker 2:You know I like doing head and neck cases. We have the James Cancer Hospital has a lot of head and neck cancer surgeries and those are kind of have some unique challenges Airway management in particular and I enjoy those types of cases but I also I don't mind really doing just having a variety of, you know, being in various places around the hospital. Every day is a little bit different and that's okay.
Speaker 1:Well, thank you so much, Dr Harder, for carving out some time tonight to meet with us. We're so sorry this is happening only two days after the national championship, but we salute your team. We'll get you one day with head coach Marcus Freeman, who's also an Ohio native.
Speaker 3:Will you be at ASA Advance next week? Okay, I'll be there as well.
Speaker 2:Awesome, Great. We'll see you down there Well thanks again, hopefully they'll be done with the snow by then, yeah right, I leave tomorrow for another trip, so hopefully.
Speaker 1:I get out. Thanks again for joining us, dr ron harter, who just finished up his term as asa president and is still serving on that executive board as we speak. Thanks again for joining us here on um on our podcast, the medical brief.
Speaker 4:Appreciate it thank you very much. Thanks, r Ron. Appreciate your time. All right For Dr.
Speaker 1:Ankit Patel and Dr Brian Schmutzler. I'm Vahid Sadarzadi. This is the Medical Brief powered by Surgeon.