My Reflections of 2018
Gary Tzeng, MD
- After hard-fought legislative challenges, Illinois finally has significant Workman's Comp reform that enforces the late-payment penalties and advances the process (beyond paper and mail delivery) into the digital realm.ISA is proud to have assisted ISMS in this important endeavor.
- While the APNs were able to advance limited expansion of their services, ISA is reassured that Legislators understand and acknowledge the uniqueness of anesthesia services and importance of the Anesthesia Care Team model and thus did not change any anesthesia-related regulations.
- Sadly, 2018 exacted a toll on ISA as we lost three of our former ISA Presidents this year. Like all ISA Presidents, each was devoted to our specialty but will be remembered for their unique legacies: Dr. John Szcewczyk as an extraordinary Parliamentarian, Dr. Usharani Nimmigadda as an amazing advocate for residents and research, and Dr. John Paul McGee as the gentle soul who strongly advocated involvement in ISA's important missions.We will miss them dearly but remember them fondly by establishing Resident Advocacy Awards that will encourage and financially support chosen residents to attend the Annual ASA Legislative Meeting.If you would like to donate to support these awards, please contact ISA (contact @isahq.org).
So enough of the past, what about the future (at least for 2019)?
- ISA has and continues to address the challenges of its delegates for its Annual House of Delegates Meeting.As you hopefully have noticed, ISA has changed the nomination process into a self-nomination process to better respect individual wishes. So PLEASE REMEMBER to NOMINATE YOURSELF if you wish to remain or become a delegate!
- We hope this change will encourage greater member participation, especially by those members who feel somewhat detached and find it difficult to become involved.And while we hope that all members representing all regions of the state will attend, we understand that logistical impossibility and therefore have removed the geographical requirements/limitations for the future delegates.But we still hope that members from all regions of our great state will want to participate as a Delegate and have their voices heard.
- The Practice Management Dinners remain popular so stay tuned as we continue to develop future dinners.If there are topics that you feel we should address, please let us know.
- The Leadership Skills Workshops have not been as popular, so those will remain on hiatus as we re-allocate those funds into our expected Legislative needs (see below).
- We have many Legislative challenges!50+ freshmen legislators will be inducted in Springfield.Most, if not all, do not have any known experience with existing healthcare legislative issues.Therefore, education will be a paramount mission for ISA and thus, ISA needs all our members' help to realistically achieve any progress.So please join us for Lobby Day in Springfield.
- The Medical Practice Act sunsets in 2019.This sunset along with the new legislature means that 2019 will be a very busy year for scope-of-practice issues.ISMS is expecting legislation from almost all allied healthcare providers including nurse anesthetists.
- As we expect a large legislative burden in 2019, I believe this year will be an opportune time to advance AA Legislation.Stay tuned as ISA continues to formalize its strategy.
- Lastly, ISA would like to thank Dr. Stephen Rublaitus for his years of service transforming ISA Today into its current modern iteration.As he steps down as Editor and I also step down as ISA's website manager, ISA seeks members who are interested in continuing ISA's media transformations.Please contact ISA if you are interested in becoming the Editor of ISA Today and/or managing ISA's website.
Our mission for 2019 remains the same:advancing the specialty of Anesthesiology in our state and ensuring the safety of our patients. So please BE ENGAGED AND INVOLVED FOR 2019!ISA NEEDS AND THANKS YOU FOR YOUR SUPPORT!
" A lot of people are looking to other people for solutions to the world we live in, pointing fingers.But we've all been called to do something for others.Everyone needs to pray about what to do.And to do it."
--Sister Stephanie Baliga, Mission of Our Lady of the Angels in Chicago
HAPPY HOLIDAYS AND HAPPY NEW YEAR!
News, Announcements and Press releases
At the House of Delegates' meeting, I took off my suit jacket and put on my lab coat. I hung a stethoscope around my neck and introduced myself as Dr. Gottlieb. I encouraged all of you to do the same when meeting your patients. I suggested that while a friendly relationship with your patient is important prior to surgery, a much more important one is of doctor-patient. Surveys have shown that many patients are not aware that anesthesiologists are physicians. Before your patient asks you if his/her doctor is going to stop by, make the importance of your responsibility clear.
But does it really matter if your patient realizes you graduated from medical school? Is it recognition we seek? Aren't we more behind-the-scenes?
It is important, and not for recognition. While we are more behind-the-scenes, I bet all of you understand the critical nature of the role you play. Medical school matters. If patients understand the extent of your responsibilities, they're more likely to share information with you, follow your instructions, and trust you. With each patient we care for, there is an opportunity to educate and inform.
So, the patient now knows I'm a doctor. Still, why is medical school important?
The focus in medical school is to be a detective. Our jobs, as physicians, is to take in evidence, process it, incorporate our experiences/education, and derive differential diagnoses. We act on the differentials and monitor to see if things improve. If they do not, we reassess, search for more evidence and derive new lists. We solve mysteries. We make diagnoses. We fight our biases and constantly reassess. This is why medical school matters. It's not anatomy class or a white coat or a diploma. Our degrees mean that we have learned how to solve the mysteries with which our patients present. Medical school is detective school. It's the place in which we learned to think critically, scientifically, and respectfully.
I have tremendous respect for every role involved in the care of our patients. While everyone contributes to the care of the patient, having a detective on the team is critical to solving problems, often when seconds matter. Take pride in being detectives! Take pride in being physicians! It's an honor and a privilege.
Beyond modifying your introductions and informing patients, what can you do?
Within your daily practice, pursue an administrative role in your hospital, call your patients the night before, the day after, an own the peri-operative workflow. Engage with surgical, procedural, nursing leadership, and demonstrate your value. Beyond your hospital, get to know your state legislators, visit Springfield with the ISA on Lobby Day, donate to the ISA PAC, become a Delegate to the House of Delegates, and get connect.
Like patients, lawmakers often are unaware and do not appreciate the route you've taken to be an anesthesiologist. If you believe, as I do, that medical school matters, educate them. Make her aware that the team model works. Invite him to see your practice. Impress upon her that your detective skills are important. Convince him that he's right to think that if he was the patient, he would want a doctor involved, too.
Thank you for all of your training, your education, your efforts, and your commitment. You do make a difference. As detectives. As PHYSICIANS.
The Legislative Journey to Independent Practice for APRN Continues...
In most other states, Advance Practice Registered Nurses (APRNs) already have full practice authority to diagnose, treat, and prescribe. Currently, there are 24 states and the District of Columbia that don't require any physician involvement for APRNs to diagnose, treat or prescribe. In addition to those, eight states allow APRNs to diagnose and treat independently but require physician involvement to prescribe.
There was strong support this year, within the Illinois legislature to grant APRNs with full independent practice. Instead of voting against physicians, legislators asked that the Illinois State Medical Society (ISMS) draft an alternative. The Illinois Society for Advanced Practice Nursing bill as introduced would have granted full independent practice and full prescriptive authority, after completing additional clinical training under the supervision of either another APRN or physician.
After numerous negotiating sessions and intense advocacy from physicians, an agreement was reached in 2017. This agreement was passed by the Legislature, signed into law by Governor Rauner, and took effect on January 1, 2018.
Below is a summary of the language that was eventually accepted by the APRNs:
- 1.Maintains the requirement that APRNs have a written collaborative agreement, unless the APRN receives substantial post-graduate training under the direct supervision of a physician (4,000 clinical training and 250 hours in additional educational/training components). The physician then must sign a written attestation confirming that the training was completed.
- 2.Does not change current practice within a hospital setting; APRNs must still be recommended for credentialing by the hospital medical staff.
- 3.Requires APRNs to maintain a formalized relationship with a physician that must be noted in the state's prescription monitoring program (PMP) if that APRN wishes to prescribe schedule II opioids and benzodiazepines. The opioids to be prescribed must be specifically noted in the PMP and APRNs and the consulting physician must meet at least monthly to discuss the patient's care.
- 4.Says APRNs are prohibited from administering opiates via injection. APRNs are also prohibited from performing operative surgery.
- 5.Prohibits APRNs from advertising as "Dr.," which is extremely misleading to patients. APRNs who have doctorate degrees must tell patients that they are not medical doctors or physicians.
- 6.Makes clear that nurse anesthetists are NOT included in the agreement; nothing changes as to how nurse anesthetists currently practice.
ISA has worked closely with ISMS on scope of practice issues and greatly appreciates that anesthesia services have been uniquely identified in the medical practice acts. While ISA has traditionally been opposed to the independent practice of non-physician providers, we've conceded that mainstream support exists for APRNs in Illinois. ISA will vigilantly advocate that anesthesia services are not the same as primary health care. We believe that the Anesthesia Care Team model provides excellent access to quality care for our patients.
Despite this expansion of privileges, the push for further independence continues. The ISA and ISMS are keeping a sharp eye focused on the APRN Compact legislation that is making ts way across the country. The APRN Compact legislates that once ten states "sign on", all states that belong to this Compact will honor an APRN's state licensure and rights of that licensure, regardless of the other states' rules and regulations. In other words, the nursing practice rules of a conservative state's license would not apply to an APRN with a very liberal license. This Compact attempts to supersede state nursing licensing requirements and regulations and is a pathway for national APRN independence.Unlike other medical and nursing compacts, this legislation does NOT respect state law.