I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader. In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts: 1) I must be getting old; and 2) This isn’t going to be easy. I came up with a short list of lessons that I’ve learned over the years. While some examples I included are anesthesiology-specific, the lessons themselves are not. Please feel free to edit, adapt, and add to this list; then disseminate it to the future physician leaders who will one day take our places.

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How to Be a Leader in
Anesthesiology & Beyond
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System

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Financial Disclosures
• Halyard Health, B Braun – Unrestricted
educational program funding paid to my
institution
The contents of the following presentation are
solely the responsibility of the speaker without
input from any of the above companies.

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There is No Universal
Answer.
How Do People See
Anesthesiologists?
How Do We Want to Be
Seen?

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Tips for Being a Leader
• First, be a good doctor.

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Being a Doctor is Still Prestigious
http://www.forbes.com/sites/niallmccarthy/2016/03/31/americas-most-prestigious-
professions-in-2016-infographic/?linkId=23952127#32bbe00e1994

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http://www.bmj.com/content/350/bmj.h2647

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Tiffany Ingham

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Wall Street Journal

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How Do These Articles
Make You Feel?
What Are You Doing
About Them?

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.

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The Era of the “Provider”

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“Hey Anesthesia!”
• 60% of the public does not know that
anesthesiologists are physicians
http://www.asahq.org/resources/publications/newsletter-articles/2015/may-2015/residents-review

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Google “Anesthesiologist”

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Anesthesiologist Defined
What is an anesthesiologist? What training is involved?
An anesthesiologist is a doctor (MD or DO) who practices
anesthesia. Anesthesiologists are physicians specializing
in perioperative care, development of an anesthetic plan,
and the administration of anesthetics. He or she has
finished college, then medical school (four years), then an
internship (one year) followed by a residency in
anesthesia (three years). Some anesthesiologists pursue
additional years of training (a fellowship).
http://www.hss.edu/what-is-an-anesthesiologist.asp

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Anesthesiologist Better Defined
http://www.kevinmd.com/blog/2014/10/love-anesthesiologist.html

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Have You Seen These Ads?

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What Is Your Desired Image?
• How do you introduce yourself to patients?
• Does it change if your attending is present?
• Do your patients know that you are a
physician? How?
• How do you introduce yourselves to other
healthcare providers?
• Do you wear a white coat? Does it matter?
Who doesn’t?

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If Anesthesiologists Are Anonymous
Anesthesia is Just a Commodity

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.
• Know the rules of the game.

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Health Care Is Changing
http://www.iom.edu/bestcare

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Publicly-Reported Metrics
• Surgical Care Improvement Project (SCIP)
metrics for anesthesia?
– Prophylactic antibiotics received within one hour
of surgical incision
– Patients on a beta blocker prior to arrival
continued it perioperatively
• Anesthesia Quality Institute, AMA, ASA, and
American Board of Anesthesiology are
working on new metrics (eg, PONV)
What is
Next (or Now)?

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The Triple Aim
Berwick et al., Health Aff (Millwood) 2008;27:759
Vetter et al., Anesth Analg 2014;118(5):1131

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Emphasis on Patient Experience
• Patients are surveyed using the Hospital
Consumer Assessment of Healthcare Providers
and Systems (HCAHPS)1
• 32 questions
• Publicly reported 4 times a year2
• HCAHPS is administered to a random sample
of adult inpatients between 48 hours and six
weeks after discharge
1. http://www.hcahpsonline.org
2. http://www.hospitalcompare.hhs.gov

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Evolution of Anesthesia Practice
• Traditional private practice models are
changing
– Horizontal integration: merging of small and large
groups to form mega-groups; some are funded by
private equity or venture capital
– Vertical integration: acquisition of smaller
practices into larger groups (ie, ACOs, HMOs)

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In the News

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MEDNAX Coming Soon?
http://www.mednax.com/newsroom/

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.
• Know the rules of the game.
• Question the status quo.

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Stop Complaining

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Design, Improvement, and Medicine

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2. Weaknesses 4. Threats
3. Opportunities
5. Potential Goals
Anesthesiology and Perioperative Care ServiceClinical Care, Education, Scholarship, Leadership
1. Strengths
Mission (2015): To provide the highest quality Veteran-centered care by leading, educating, and innovating in anesthesiology and perioperative
medicine.
1. 1st Example 1. 1st Example
1. 1st Example 1. 1st Example
How Are You Doing?

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Have a Vision
• To be the model for change and evidence-
based medicine that improves Veterans’
health and well-being.
http://www.paloalto.va.gov/anes_mission.asp

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.
• Know the rules of the game.
• Don’t be satisfied with the status quo.
• Establish trust and celebrate team wins.

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My Team

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We Work as a Team
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
FY11 FY12 FY13 FY14 FY15
NUMBEROFENCOUNTERS
ANESTHESIA OUT-OF-OR ENCOUNTERS FY11-15
Total
419 PRE/POST
420 PAIN
427 REGIONAL
434 NON-OR/APS
441 PHONE

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0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012 2013 2014 2015
Publications in Peer-Reviewed Journals Cited on PubMed
Anesthesiology/Critical Care Pain
We Share Knowledge as a Team

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We Innovate as a Team
Mariano, Walters, Kim, Kain. A&A 2015;120:1163
Walters, Mariano, Clark. Pain Med 2015 July 14

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.
• Know the rules of the game.
• Don’t be satisfied with the status quo.
• Establish trust and celebrate team wins.
• Be open to opportunities even it they sound
like more work.

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Know When to Take Off the Mask

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Volunteer and Get Involved
• Operating room (Chair)
• Pain (Chair)
• CPR (Chair)
• Research and development (Chair)
• Invasive procedures (Co-Chair)
• Clinical Product Review (Co-Chair)
• Professional standards board (Vice-Chair)
• Peer-review (Vice-Chair)
• Transfusion (Member)
• Laser safety (Member)

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Everyone Starts Somewhere

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Nothing is Easy
Email from a senior faculty member to the
entire department shortly after I started:

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Tips for Being a Leader
• First, be a good doctor.
• Have an identity.
• Know the rules of the game.
• Question the status quo.
• Establish trust and celebrate team wins.
• Be open to opportunities even it they sound
like more work.
http://www.edmariano.com/archives/829