Central Line

Episode Number: 165

Episode Title: The President’s Episode

Recorded: June 2025

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VOICE OVER:

Welcome to ASA’s Central Line, the official podcast series of the American Society of Anesthesiologists, edited by Dr. Adam Striker.

DR. ADAM STRIKER:

Hello, and welcome back to Central Line. I'm Dr. Adam Striker, your host and editor. Today we have a special treat. Dr. Don Arnold, ASA's current president, is here to talk with us about his pathway and trajectory, as well as some of the challenges the specialty is grappling with, but hopefully also some of the opportunities we have as well. Dr. Arnold, we are excited to have you on the show today.

DR. DONALD ARNOLD:

Adam. It's a real pleasure to join you.

DR. STRIKER:

Well, a lot of times we start off with our guest telling our listeners a little bit about themselves and their background. And so why don't we do that? If you don't mind, tell us a little bit about your background, how you got to where you are, maybe a little bit of your life history, and also why starting your professional career in the state of Missouri is always so beneficial.

DR. ARNOLD:

Well thank you. And probably some of the listeners don't know that, uh, Adam and I have some similarities in our background, both starting off on a professional career track as engineers. Um, I'm a native of Wisconsin, studied engineering as an undergraduate, and went to medical school, uh, in Madison, the University of Wisconsin, where I really found some of my professional roots in anesthesiology.

Probably if I look at medical school training in my early professional career, I wasn't sufficiently self-aware enough to realize the real active, uh, mentorship and sponsorship that I had the benefit of, of receiving, uh, really some stellar anesthesiology residents captivated my interest in the specialty. Uh, an anesthesiologist and dean at the University of Wisconsin, Betty Bamforth gave me advice and was a frequent ear for me during medical school and as I began to look at residency programs, helped me find my residency home at Dartmouth, where I had the benefit to train in a small program with incredibly energetic faculty and two real significant professional mentors. Uh, Harry Byrd, who was president of the ABA and president of the ASA, uh, and Dave Glass, who also was a president of the ABA. Uh, the expectation that they created, uh, for residents in that program, uh, and the opportunities that they provided to graduates as they left the program really were were phenomenal.

And it was through relationships at Dartmouth that I found my first job after training at Washington University. I was the trailing spouse. My physician wife found a fellowship program that she was interested in at Washington University in Saint Louis, and my mentors at Dartmouth connected me with Bill Owens, another well-known anesthesiologist. And Bill helped provide opportunities for me within ASA and within the American Board of Anesthesiology. And then there were obviously a number of people after that who influenced my career, provided me with opportunities. But I had the opportunity, after a short period of time on faculty at Washington University, to transition into an independently managed practice in Saint Louis, where I really have had the great benefit of working with phenomenal colleagues in a high performing, challenging healthcare system that has provided not only the professional stimulation that has really been captivating for me, but the ideas, the thought generation that has come out of our practice and out of the Missouri Society of Anesthesiologists have helped me take ideas from Saint Louis and Missouri to the ASA level, and the opportunities that I've had to engage with ASA.

DR. STRIKER:

Well, you've been in this role now for, what, eight months, I guess 8 or 9 months, and certainly been involved in the ASA for many years. But were you truly prepared to take on the role of president once you got there? And then also, what has surprised you the most about that role now that you're in it?

DR. ARNOLD:

Yeah. Great question. And probably the first thing I need to say about preparation for president, uh, is it's not all about me, right? The most important thing that I can say is that there is certainly nothing that I could do--and ASA would also be particularly limited--without the engagement of of members who make everything that ASA does possible. Um, we need members engaged and executing in their daily work at the bedside, and clinical leadership and administrative leadership in, in hospitals and in health systems. And the work that individual members are doing really supports and enables the work that ASA does on a broader level. And within ASA, the engaged members on committees and committee leadership and in various leadership roles within the organization, paired with a really actively supportive ASA staff, is what makes ASA successful and what helps position officers to succeed in the roles that they have within the organization.

DR. STRIKER:

Has it gone fast?

DR. ARNOLD:

You know, I think it has gone fast, and it's in particular in the past couple of months. It's been going faster just about every week. And I have been encouraged along the way by the incredible support that I have received. Every time there has been a need, whether it is from other ASA leaders, from committees, from members, I have been so impressed with the way that members have stepped up and helped provide the subject matter expertise, the work that we need in particular areas, because without that, ASA couldn't accomplish the things that we have been able to do this year.

DR. STRIKER:

You know, one thing that has always been fascinating to me is the sheer weight of that position and the demands of that position from outside looking in and how people handle that, balancing it with their work life and personal life. How is that? We all know it's pretty much a full-time gig to sit in that position, but navigating your clinical professional life and any personal interests… Do you have any? Do you get to participate or is it pretty much you're putting your life on hold for a year? I just find that topic fascinating, and I have to think a lot of individuals are curious about how that works.

DR. ARNOLD:

Everyone manages things slightly differently, I would say, because everyone's personal, professional and administrative roles are a little bit different when they step into this office. I have reduced my clinical footprint some during the year. I have maintained administrative roles in our hospital and in our health system. And I've been able to balance that really by the great team that I have the privilege of working with, both in Saint Louis in my day job and within ASA. Uh, we have a remarkably effective and capable staff members and leaders both on the executive committee and administrative council, but also throughout the organization where we have section chairs and committee chairs, leading work by member volunteers.

If we do an effective job at engaging members in roles that they have within ASA, that makes things a lot easier. So I have had no delusion that anything I'm accomplishing this year is by by virtue of my own activities and my my own personal efforts. It really is a team-based approach that has helped propel ASA forward. And I think, um, if you talk with other presidents, past presidents, and if you talk with officers who will be ascending to presidency over the next couple of years, they would probably tell you that they think that that's key.

DR. STRIKER:

Well, let's go ahead and talk a little bit about the specialty. I want to get your thoughts on how you think the health of the anesthesiology profession is in general. Where are some aspects that we are doing well in, and are there things on the horizon that you think we should be looking forward to regarding this specialty?

DR. ARNOLD:

Well, a lot to talk about there. So I think, first of all, um, what are we excelling at? I like to think that one of the areas that we are executing well on is, uh, understanding ASA, understanding our profession, in how we develop and execute our strategic plan and then our strategic priorities and tactics that that support that plan. It's no surprise to anyone who may be listening that this is really a pretty unique time in our country. Uh, given the political and regulatory environment, uh, that has been developing in a, in a new direction in 2025. And it has been particularly important for us as we seek to understand the environment of change and seek to understand our opportunities, uh, to remember what are the things that we hold as our values as an organization. Patient safety, physician care, scientific discovery. Because those issues, really informed by the great, uh, necessities of this time, help us execute within the parameters of our strategic plan. And I think doing that has been particularly helpful. Each of us in our day jobs are dealing with health systems that all have some resource constraints. That's certainly true on the ASA level, where there are constraints in terms of human resources, in terms of financial resources. So we need to be wise and we need to work in a very priority driven manner. Uh, and I think we've done a good job of that in a very difficult time.

DR. STRIKER:

Well, and on the flip side, what are things that anesthesiologists should prepare for, or what are challenges that may be on the horizon for us, specifically as anesthesiologists?

DR. ARNOLD:

Right. Well, there's there's a lot of good things right now. Right. Um, there's an increasing demand for surgical and procedural services. There is demand for the services that we provide. There is some increase in the development of anesthesia professionals, both anesthesiologists and anesthetist. And we have an explosion of not only interest in the specialty, but new knowledge that supports healthcare in our space. So there's a lot of good in in all of that. But I think there's certainly some challenges in the midst of this, and areas that we are identifying challenges are areas that we're building to solve.

One of the areas is our Center for Perioperative Medicine, which is an effort to provide foundational support not only within the ASA but for the profession to look for ways to be evolving care paradigms for anesthesia care in the future, leveraging not only the knowledge base that we have but new technologies that are available and applicable in this space, and the ability to really question what's what's the best way to provide continuum of care support from the decision to operate until specifically defined post-procedural outcome period. So leaning into developing new ways of doing the work that we're doing. I think that's key.

Second, we have to realize that there are workforce challenges that come along with this time that we're in. In the Center for Anesthesia Workforce Studies helps to inform and prepare the specialty for the demands on the workforce and hopefully identifying some new solutions to our workforce challenges. There have been a couple of summits. There has been a leading article in Anesthesiology, and there's continuing work to develop strategies and toolkits to help practices and help departments manage through the tough environment that we're in right now, where in most settings, the demand for services really is slightly outstripping the capacity to provide care. Um, on one hand, the economics and the reality of scarcity has some benefits. On the other hand, that can be burdensome not only on a department and practice level, but on an individual level as well. So solving for workforce needs is important.

Then finally, probably our third center I'll mention is the Center for Anesthesia and Perioperative Economics, CAPE. This is the youngest of of these three centers, but it is a center that is tasked with standing up and developing new approaches to both analyze, study, and support economic advocacy for the specialty. Um, these three centers are addressing the areas of need within the specialty, uh, evolving practice, responding to workforce needs, and looking in a strategic manner at the economics that support the specialty. And I think that's how we're stepping into addressing these areas of needs, Adam.

DR. STRIKER:

You know, you're in a unique position, and you had alluded to this earlier about the broader healthcare landscape, given what's going on in current regulatory agencies and a lot of the turbulence in government, and from your unique perspective, the healthcare landscape in general, what are things that we should maybe be aware of or concerned with or keep a close eye on? Obviously, we you know, a lot of us follow the kind of the mainstream news. But from your perspective, have you identified anything within the broader healthcare landscape that that might be interesting for us to know about that we might not have seen before?

DR. ARNOLD:

You know, it's it's a good question. And there's probably among the diverse group of listeners that may be reflecting on our conversation, there are probably individuals with varying levels of either interest in or awareness of some of the details that are inferring the current health care landscape. So I think a couple of things are worthwhile mentioning. First of all, the focus that the current executive branch has taken is different than we have seen recently. There is a lot of thought generation and planning that's coming out of the not only from the president, but the White House Domestic Policy Council, and a lot of the thought processes that are being introduced into the government of the federal level are coming from advisors, uh, who populate positions in the government, many coming from the Paragon Health Institute. Um, for those listeners who may be interested, if you look at the Paragon Health Institute website, you'll see position papers on Medicare, Medicaid, commercial payers and in public health. And a lot of the ideas there and in the 2025 plan are ideas that we're seeing expressed in policy by the current administration, uh, as we encounter this. We understand some of the ideas that are coming up. Some of the questions that are, are being asked, some of the steps that are being taken from an anesthesiology perspective. And on behalf of ASA, we're trying to be thoughtful in terms of identifying what are those issues, what are those areas that are unique and uniquely important for anesthesiology, and engaging effectively in those areas, trying to understand very specific issues thoughtfully and engaging thoughtfully in in work on anesthesia specific issues. But there's a lot of potential for broader changes that may impact anesthesiology, but are really of an interest to the broader house of medicine. And in these areas, we're really seeking to collaborate effectively with other medical societies so that our combined work strengthens the visibility and voice that we're trying to bring to the specific issues, whether it is Medicare payment practices, whether it is access to insurance and coverage, whether it is abuses of the massively vertically integrated commercial health insurance industry. Tackling many of these larger issues really requires a coalition approach, and that's what we're trying to do.

DR. STRIKER:

That brings up a good question. I know we collaborate quite a bit depending on the issue with other medical societies. Has the current environment allowed for more of that than than you would have otherwise expected in previous years, or is it about the same, and it just depends, just because of the issues that are at play currently?

DR. ARNOLD:

There is probably a greater degree of intense efforts to dialogue, collaborate, think compromises between medical societies than we may have seen in the past. And I think part of the reason for that--and I'm not going to make a value judgment of whether the changes that we're seeing are good or bad--but the pace of change in Washington is certainly accelerated. And there will be many listeners who are pleased to see our federal government moving more quickly than it has in the past. But what that requires really is a higher degree of engagement, and that has really driven in, in my estimation, a high degree of work between ASA staff and physician leaders, with staff and leaders for other medical societies working on particular issues, trying to identify areas where we have a common cause, and then thoughtfully developing positions that we think can be introduced and have an impact in shaping the dialogue nationally.

DR. STRIKER:

Well, let's shift directions just a little bit. I want to talk about the ASA specifically. Our society and the value of membership we've covered in the past on this podcast. In fact, I think our our very first live podcast session from the annual meeting was all about this. We had a really interesting panel about the value of membership. But what would you say to someone starting out about the importance of involvement with the ASA? I know specialty societies have evolved over time. The priorities have shifted, and the membership obligations have probably changed over the decades. And what the expectations were for people of a certain specialty. So what do you say to someone now starting out? What the value is of being involved in a society like the ASA. And likewise, what would you say to someone who's further along in their career that also may not be as involved in the society as we would like?

DR. ARNOLD:

Another great question, Adam. And as you were asking that you reflected on the, you know, the fact that there's been panels on this. So there's obviously a lot of perspectives, and you can spend a lot of time answering this question. And from my perspective, I like to to break it down into a pretty simple analysis. We do want the ASA membership to be able to demonstrate a value proposition for our members. And the value in membership is expressed in a number of different ways and probably experienced by different members a differently. And there are different aspects of ASA that are more deeply appreciated by some members than others because of the great diversity of our membership.

I think the first and foremost thing that young anesthesiologists should consider is that healthcare is an incredibly regulated industry. It's an incredibly regulated sector in our economy and in our country. For good reason. But if you look at healthcare in general and you look at healthcare historically, it is probably within healthcare and from physicians where you have a group of workers, a group of professionals who are incredibly regulated, but probably nowhere else do we have a lower degree of engagement in addressing the environment that regulates anesthesiology in the health care industry. If you look at the energy industry, if you look at other professional services, whether it's accountants, whether it's lawyers, you see throughout regulated industries a high degree of engagement in professional organizations as the means to not only effectively understand the regulatory environment, but to effectively advocate on behalf of our patients within the multi-jurisdictional federal, state and local regulatory environment that impacts health care. So getting engaged is incredibly important. And that engagement then provides the diversity of thought, the diversity of ideas that fuels ASA. The reason that ASA has been successful is a is a professional organization, is the strong engagement of our members. And if we look at our members, we have diversity not only in terms of personal characteristics but in terms of professional roles, clinical work, administrative work. We have individuals at different parts of their career arc, and everybody sees the profession and the needs a little bit differently, and the opportunity is to get involved, to make sure that your voice is heard, to make sure that you have an understanding of what is being done on behalf of anesthesiologists in the United States.

DR. STRIKER:

Is there something that you wish members understood better about the ASA?

DR. ARNOLD:

There's probably two groups of people that we speak to, right members and non-members. I think members do understand that ASA as an organization works hard to deliver value and provide value in membership. I think the average member, though, may need a little bit of encouragement if they have questions, if they have concerns to to reach out to ASA, either through their state components, through their state directors, reaching out to the top of the organization. I receive emails on a daily basis through email at president@asahq.org, and try to respond to inquiries that come in. I think that there's a significant opportunity for members to dialogue with each other through ASA Community that is not only a great forum for identifying issues, processing ideas, but we're also using that within ASA to scrape ideas and scrape discussions that come off of of communities that are identified by community to help us identify needs for the profession. So I think those are a couple of key things and key opportunities to engage that every member could and should think about. Um, I think the other question is what would I say to non-members? And I think the issue for non-members is we would love to have you join our membership, and we would love to understand what concerns you have about ASA. Maybe you believe that there's gaps about things that ASA should be doing that hasn't. We'd love to hear about opportunities we may have to better serve the profession well. And an important voice of that is individuals who may be skeptical about joining ASA.

DR. STRIKER:

Well, I'm going to pick up on the way You just laid that out and ask what can members and also non-members do to get more involved to help the society.

DR. ARNOLD:

Right. We have a fair amount of information. For members It's a little bit easier because there are resources for members that provide opportunities and pathways to engagement within the organization, whether it is nominating yourself to participate in committees, whether it's involvement in state component work, whether it is as a young careerist identifying the need and the interest in in mentoring. Not every department, not every practice, has effectively strong mentor mentee environments. So we have a mentorship program that connects members who are seeking mentoring, and those who are seeking to mentor others to connect them. We're identifying opportunities for members to participate in meetings through presentations, submitting either panel ideas, submitting papers, publishing letters, or content to monitor. There's a host of ways for individuals to express their professional interests.

DR. STRIKER:

Let me give you an example of something I've heard at at another conference. And, you know, somebody's not an ASA member, certainly has had a pretty distinguished career in anesthesia, say, like the ASA, you know, I don't think they even want me based on my, my opinions. And I just I don't get involved in that or I don't want to get involved because I disagree with the ASA. And I'm kind of paraphrasing, you know, but what do you say to that person that's a non-member, that's somebody, you know, a well-to-do anesthesiologist, I think, would be a valuable voice to have in the organization. I can tell you what I said to them, which was basically, you should get involved. These are you're exactly the type of person we want, somebody who has a different viewpoint, who has a long history of experience that that we can draw upon. But what would be the best avenue for someone like that to get involved?

DR. ARNOLD:

Yeah. So, you know, I think what you offered is, is a great perspective. Um, within the profession, we are stronger together, we're stronger with more members, and we are stronger with increasing diversity of ideas and questions about what our organization should be doing. I think it's probably useful for someone who may be skeptical about whether they should join the ASA, or skeptical about the benefits of their membership to to reach out and maybe colleagues within their practice. It may be colleagues in their state. It could be any ASA officer would be glad to to talk with ASA members or non-members about what we see as the value of ASA, and why we see that even someone who hasn't contributed has the opportunity to have their voice, their perspectives, understood and integrated into the work that we do on behalf of the profession. Because as ASA serves members individually, we're at the same time serving the profession broadly, serving subspecialty organizations broadly, with a laser beam focused on what can we be doing to improve patient care. And everybody has ideas and perspectives about that central organizing theme.

DR. STRIKER:

Well, before I let you go, I'm wondering if you can pass on some leadership advice to our listeners. What's your best leadership tip, and has a mentor or someone in your professional past giving you advice that's made a difference in your career?

DR. ARNOLD:

Yeah, I think, you know, as I started off the hour, I think I named a few people who were incredibly impactful for me in my career. And again, I say, I think I said then and I'll repeat now, I probably wasn't self-aware enough at the time to realize what the incredibly positive influence these individuals were having on my career. Uh, leadership tip, I spent the last hour with you talking quite a bit. Probably one of my leadership tips is to show up and listen and listen a lot and and learn. And then, find areas of interest, whether it's in your practice, whether it's in a clinical subspecialty, whether it's in clinical leadership, whether it's in administrative law, find something in the profession that you have a passion for. We have a host of communities across a range of professional interests. Find an area that you're interested in. Communicate your interest to the leaders of your practice, leaders of ASA committees. And then show up. Once you've shown up and you're at the table, volunteer. Take on a project, accept an assignment, and and get that work done. If that's something that feeds you, if that feeds your soul, if it satisfies professional interests and curiosity, keep it up. Keep your ears open and follow the leads of individuals who are giving you opportunities to contribute more.

DR. STRIKER:

Well, wonderful advice and a great way to leave the conversation. Dr, Arnold, thank you so much for joining us to discuss all sorts of issues that affect the ASA, and it's been a real pleasure.

DR. ARNOLD:

Adam, thank you very much. It was an absolute pleasure to join you.

DR. STRIKER:

And for our listeners, I hope you enjoyed this conversation. Don't forget to tune in again next time and tell some colleagues about the podcast. If you enjoy these conversations, please don't forget to leave a review on your favorite podcast platform and tune in again next time. Take care.

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DR. SENTHIL SADHASAVAM:

Hi, this is Dr. Senthil Sadasivam with the Asthma Patient Safety Editorial Board. 30 day postoperative mortality is the third leading cause of death in the US and the world. Reducing costly postoperative mortality. Major adverse cardiac and cerebrovascular events, otherwise called Mais, postoperative delirium and cognitive dysfunction is a critical unmet public health need. Proactive preoperative pre-operative prediction and prevention strategies can help. Proactive perioperative risk predictions include comprehensive evaluation to identify high risk surgical patients, including frailty assessment using tools such as Clinical Frailty Scale, then vigilant assessment of intraoperative triple low events and possible use of intraoperative neuromonitoring in high risk vascular and cardiac surgical patients to predict postoperative mortality, stroke, and postoperative delirium. Perioperative interventions include personalized pre-operative prehabilitation cognitive training such as lumosity physical exercise, either aerobic or strength training, enhanced social support, proactive depression management, and improving sleep quality and hygiene. Postoperative mortality, maze depression, delirium, and cognitive decline are major public health problems. They are. Perioperative risk prediction can help with proactive mitigation and prevention, with rehabilitation as well as pre-operative cognitive and behavioral training. In addition to personalized perioperative interventions.

VOICE OVER:

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