|Year : 2015 | Volume
| Issue : 3 | Page : 291-292
Mukul Chandra Kapoor
Department of Anesthesiology, Saket City Hospital, New Delhi, India
|Date of Web Publication||29-Jul-2015|
Mukul Chandra Kapoor
6, Dayanand Vihar, New Delhi - 110 092
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor MC. Empowering anesthesiologists. J Anaesthesiol Clin Pharmacol 2015;31:291-2
"The first cut from the inside was completed, and the bloody blade of the knife issued from the quivering wound, the blood flowed by the pint, the sight was sickening; the screams terrific; the operator calm." New York Herald (July 21, 1841) describing an amputation.
Anesthesiologists are the backbone of all surgical specialties and are the primary caregivers in critical care. Surgery before the days of anesthesia was gruesome. Advances in surgery would not have been possible without the support offered by an anesthesiologist. Till a few decades back, the image of an Anesthesiologist was that of a technician relegated to the background. Anesthesiologists have grown from being "junkies"  to skilled "perioperative physicians." With advances in the techniques, equipment, knowledge, and training, anesthesiologists have come out of their shells and are more visible today.
Today, apart from delivery of anesthesia, anesthesiologists perform multiple duties, which include overseeing schedules for staff; resolving clinical care related issues; managing postoperative care; participating in hospital committees or boards; interfacing with other departments; and overseeing quality assurance. Anesthesiologists are thus potential leaders in healthcare management. Many managers take inputs from anesthesiologists to appraise the performance of other doctors. Physician colleagues take their input to decide the need for surgery, and the surgeon to choose to perform the operation, as the experience of the anesthesiologist about surgical processes is unmatched. Such exposure to management issues makes anesthesiologists ideally suited to lead as hospital administrators.
The specialty needs to grow out of its semi-visible status and be recognized as a prime player in healthcare. The place of anesthesiologists in the western world is well-established today, and the specialty is much sought after. The same can't be said for the specialty in our country. One major reflection of the difference, in the status of anesthesiologists, in the two worlds is the disparity in earnings. The average salary for an anesthesiologist is Rs. 967,325 per year in India.  On the other hand, the median earning of an anesthesiologist in the USA is $343,000 (which goes up to $363,000 with bonuses) that is, approximately Rs. 21,266,000, which is more than 20 times the Indian average.  As per the Medscape Physician Compensation Report 2014, anesthesiologists are among the top 6 earners and the only surgical specialty earning much more than the anesthesiologists is orthopedics.  Unfortunately, no agency in India has surveyed the earnings of doctors in the private sector. Although it is well-known that anesthesiologists are compensated lower than other physicians, there are no published figures to highlight the same.
Anesthesiologists in our country have not been able to get out of the shadows of the surgeons. Remunerations for anesthesia services are linked to surgical fees, which is indicative of anesthesia being a subservient service. The insurance payouts have no provision for anesthesia fees as if the specialty does not exist. In the private sector, remunerations for anesthesia service are generally a third of the surgical fee, treating anesthesiologists as poor cousins. The fallout of this is that hospital managements treat anesthesiologists as second fiddle, while they pamper the surgeons.
There is a need to delink payout for anesthesia services from the surgical fee. Anesthesiologists are independent physicians and administration of anesthesia is not just dependent on the surgical process. Co-morbid conditions in a patient may make a simple surgical procedure complex for the anesthesiologist. In most of the developed world, anesthesia billing is by Relative Value Guide structure based on a unit system, which reflects the complexity of the service and the time the physician took. , Under this structure, fee for an anesthetic service comprises up to four unit components:
- Basic unit value (based on the surgical procedure - listed in a table issued by the Medicare Agencies or professional association).
- Time unit value (based on time devoted by the physician for the procedure - generally 15 min is considered as 1 unit).
- Modifier unit (based on co-morbidity associated, emergency "in hours," emergency "after hours" - where applicable).
- Therapeutic/diagnostic services (additional monitoring or therapeutics such as arterial line, postoperative pain relief - where applicable).
The anesthesia payout is calculated using the formula: Anesthesia payout = ([base unit value] + [time unit value] + [modifying units]) × conversion factor. The conversion factor varies from state/country and presently is about US $20 in most states. The payouts for therapeutic/diagnostic services are added separately.
There is an emergent need to develop an anesthesia payout program to enhance the stature of our specialty. We need to come out of the shadows of the surgeons and the first step to achieving this is economic independence. A national payout policy needs to be drafted in collaboration with the Indian Medical Association. Our professional associations and societies should take up this matter with ferment vigor and determination. Its time all of us rise from our slumber!
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