When the COVID-19 epidemic arrived in the United States, we did not have adequate testing capacity, partly because testing depended on a CDC-developed and distributed polymerase chain reaction (PCR) test that eventually was found to be faulty, probably as a result of contaminated reagents. Fortunately, the FDA was able to use a provision called emergency use authorization (EUA), which allowed the rapid deployment of other COVID-19 tests without requiring that they undergo the full FDA approval process.
It is obvious that in a public health emergency like COVID-19, getting an accurate and timely test result is important not only for the individual patient and their caregivers but for the public at large. False-positive or false-negative results can contribute to the spread of COVID-19.
With many EUA kits available, it is reasonable to assume that the real-world clinical performance of these tests may vary, and so we believe that it is essential to have comparative clinical performance data to ensure that only the best tests survive.
So, what should anesthesia specialists do? John G. Brock-Utne, MD, PhD and Richard A. Jaffe, MD, PhD of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, suggest that until the clinical reliability of the COVID-19 test used for screening your patients has been clinically validated compared with other tests, you should prioritize your own safety and use an N95 mask, face shield, gloves and gown for every patient. This is especially true for intubation, extubation and during aerosolizing ENT cases.
While the FDA’s EUA process ensures the rapid availability of COVID-19 tests, it does not mean that we should trust them all equally.
Protecting the Future of Our Profession
You have probably heard that our profession is facing threats from third-party payors, the government and advanced practice and nonphysician practitioners. The real question is, how should we deal with the upcoming “market adjustment” that almost certainly will result in lower compensation for anesthesia specialists? Also, how can we promote pride in our profession and recruit the best medical students? How can we continue research that will reduce risk and improve outcomes?
First, it would be wise to assume that a downward market adjustment to anesthesiologist compensation is coming. Plan for it now by managing your spending and putting away all you can in a tax-deferred retirement account.
The days are over when it was enough to learn to deliver anesthesia competently in order to get a decent job. We need to do more to establish our value beyond simply putting patients to sleep and waking them up. Set yourself apart from advanced practice and nonphysician practitioners. Anesthesiology residents today are well advised to specialize. Do a fellowship year or two, pursue advanced training in clinical research or consider working toward a PhD. Make your skill set unique and your services indispensable to your hospital or group.
Nothing is stopping us, at least today, from exerting the clinical decision-making ability we have as physicians. It’s best never to make a decision for fear of criticism after the fact. 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.
Cross-training with other specialties will expand, and anesthesiology’s influence will expand accordingly. When 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.
Developing technology will also help redefine delivery of care. Anesthesiologists will no longer spend disproportionate amounts of time performing nursing and pharmacy tasks. As anesthesia specialists work smarter, the desires of upcoming generations for predictable schedules and career satisfaction can be fulfilled.
COVID-19 Testing: Is It to Be Trusted? anesthesiologynews.com
Practice Without Fear: Advice for Residents on the Future of Our Profession. anesthesiologynews.com