Not long ago, ASA CEO Paul Pomerantz and I discussed the downward pressure on exhibitor fees at the ASA annual meeting. It’s an important topic because ASA derives about 18 percent of its total annual revenue from the meeting, and more than 40 percent of that comes from our exhibitors.

The problem, more and more, is that the vendors are questioning the return on their investment in displaying their products on our exhibit floor. They suspect that our attendees, overwhelmingly practicing anesthesiologists, are no longer the decision-makers driving purchases in their health care organizations. Put simply, it appears to the exhibitors as though we’re no longer the leaders.

The conversation reminded me of the Rovenstine Lecture that Peter Pronovost, M.D., Ph.D., delivered at the annual meeting in 2010. His address, “We Need Leaders,” tackled the issues of improvements in patient safety and the multiple levels of leadership that made those advances possible.

One of the reasons I remember the speech so clearly is because of a rhetorical device Dr. Pronovost employed in its delivery. Nearing the end of his talk, he enumerated a lengthy series of patient safety goals, beginning each with “Now is the time to …” and ending with the simple declarative, “We need leaders.” The mantra drove home his message and made for an unforgettable lecture.

If I had one criticism of the address, though, it would be that Dr. Pronovost took a limited view of the innumerable roles for which we do, in fact, need leaders. We don’t need leaders just for the advancement of patient safety; right now our specialty desperately needs leaders on every front.

If the rewards and satisfaction of a career in anesthesiology were graphed on the abscissa and the passage of time on the ordinate, our current situation places us at a dangerous point of inflection on that trajectory.

With our successes in engineering, pharmacology and myriad other areas of research, anesthesia is safer than it’s ever been, despite an ever-sicker patient population. We’ve been compensated well financially over the past decades for overcoming the inherent dangers of rendering patients insensate to the pain of surgery and supporting their circulation and respiration when we’ve deprived them of the ability to do so for themselves.

But we’re now at a crossroads where anesthesia is beginning to be perceived as so safe that paying for physician leadership in its administration appears to add insufficient additional value to the health care marketplace.

We need leaders to demonstrate that anesthesiologists not only provide the best care, but do, in fact, add value to the American health care system.

We need leaders to prove that anesthesiologists, not independently practicing mid-level practitioners, will continue to expand the knowledge base of the specialty and improve the care that all of us someday, unfortunately, will require.

And we need leaders to carry these messages to the public and to the legislators who define our national priorities.

We need this leadership at every level: within our practices, on our hospital committees, in the executive suites of our hospitals, in the deans’ offices of our academic institutions, as the CEOs of our integrated health care systems, in organized medicine, in our communities and even in our government. We need physician anesthesiologists to be those leaders.

Accordingly, ASA wants to be a resource for its members as they advance to fill those positions. In 2016 we began an Executive Physician Leadership Program in coordination with Northwestern University Kellogg School of Management. It has sold out every year. Last year, the ASA Administrative Council included Health Systems Leadership as a “Strategic Pillar” in ASA’s “2020 Vision for the Future: Contract with our Community.” And in January of this year, ASA President James Grant, M.D., M.B.A., FASA, announced an exciting new collaboration between ASA and the American College of Healthcare Executives (ACHE) that will yield opportunities for our organizations to partner on physician leadership development.

ASA members currently serve as:

• ■ CEOs of the University of California, Davis, and Dartmouth-Hitchcock Health systems.
• ■ Executive Vice President for Health Affairs at the University of Kentucky.
• ■ Chief Operating Officer of New York-Presbyterian/Columbia University Medical Center.
• ■ Surgeon General of the United States.
• ■ A member of Congress in the U.S. House of Representatives.

While ASA certainly wants to encourage and support members aspiring to these lofty heights, not all of us can or need to be engaged at this rarified level.

As Dr. Pronovost said in his Rovenstine Lecture, “You do not have to be the smartest or the strongest or the most powerful or the most influential. You also do not need to be the department chair … You simply need to have courage to think of what could be, clarity about the task at hand and commitment to convert these thoughts into a reality.” He added, “Leadership is helping people address problems that will make the world better. It means focusing on a goal and inviting everyone to help achieve it. It means serving others more than ourselves.”

So, in fact, each of us can be a leader. The anesthesiologist who encourages every member of his or her group to be a member of ASA, their state component and state medical society is a leader. The anesthesiologist who inspires others to donate to political candidates and organizations that support the medical specialty of anesthesiology is a leader. The anesthesiologist who volunteers to serve on medical staff committees is a leader. All of us, no matter where we’re pigeonholed on the organization chart, can be leaders.

Sadly, we’re currently a little short on leaders. In fact, too many anesthesiologists are instead locker slammers. What’s a locker slammer? A locker slammer is the antithesis of a leader. A locker slammer is the anesthesiologist who arrives in the morning, provides or medically directs anesthesia in the operating room for a list of surgical patients, drops the final patient of the day off in the PACU, goes straight to the changing room, changes clothes and then slams the locker door and walks out of the building.

Locker slammers add insufficient value to the medical specialty of anesthesiology. They don’t expand the knowledge base of the profession or improve care. They contribute little that a mid-level practitioner could not contribute. They don’t enhance the reputation of their anesthesia group, their health care system or the profession of anesthesiology. They deliver clinical anesthesia, period.

It’s ironic that some of us may even have chosen anesthesiology as a profession specifically because it lends itself to locker slamming.

Locker slammers might administer an excellent anesthetic. They may well be compassionate and caring physicians, loving spouses and wonderful parents.

But, right now, we need more. We need leaders.