Allocating Subspecialist Pediatric Anesthesiologists

Abstract

In Response: In our editorial, we primarily addressed the issue of subspecialty training for pediatric anesthesiologists. Accreditation of programs (not of individuals) by the Accreditation Council for Graduate Medical Education provides standardization of this process. Graduates are trained to care for high-risk patients. Atkins is disturbed, however, by what he believes is a trend by some families and pediatricians to desire that a pediatric anesthesiologist be involved in the care of their children. This is an issue that is influenced not only by the personnel available in an institution, but also by the standards and expectations of the community. For instance, do individuals understand and appreciate the differences between the qualifications of an anesthesiologist versus an anesthetist, or between a board-certified versus a non-board-certified anesthesiologist? Similarly, do they even know that some anesthesiologists have special experience and/or training in pediatric, pain, obstetric, or cardiac care, among others? These are intriguing matters that our editorial did not address, primarily because the local environment frames these questions differently. Moreover, this is not simply a concern for anesthesiologists. For example, some parents bring their children to a family practitioner; others bring them to a pediatrician. Some feel comfortable with an adult specialist (such as a surgeon, cardiologist, etc.) providing care for their children, whereas others prefer a pediatric specialist (such as a pediatric surgeon, pediatric cardiologist, etc.). Likewise, some parents and pediatricians (as well as pediatric surgeons) prefer that their children receive care from a pediatric anesthesiologist rather than from a generalist. Individuals who request this are likely seeking an anesthesiologist with special training and/or experience in the care of children. In most situations, a careful explanation of one's background, along with appropriate reassurance, is all that is necessary. Nevertheless, the ability to choose one's own caregivers is an important aspect of American medicine. Hopefully, this will not be lost in the current restructuring of reimbursement for medical services. Patients and families who wish to know the education, training, and experience of their physicians certainly have that right, and many medical societies are already making this information available to the public via the Internet. Attempts by regulatory agencies or practitioners to discourage patients from seeking specialty or subspecialty care are unwarranted and inappropriate. However, as Atkins notes, it is important for the leadership in pediatric anesthesia to help all anesthesiologists who care for children. This means providing not only consistent, high-quality subspecialty training, but also education for the generalist anesthesiologist. The pediatric anesthesia community has been particularly responsive in this regard. We invite Atkins and all others interested in the care of children to take advantage of the many educational opportunities in pediatric anesthesia, such as those offered through state and national anesthesia societies, including the two annual educational programs of the Society for Pediatric Anesthesia. It is also worth noting that the Society for Pediatric Anesthesia welcomes as members all anesthesiologists with an interest in pediatric care. This is because it is clearly in the best interest of children to have anesthesiologists who provide pediatric care continually updated in their knowledge, as well as experience. Mark A. Rockoff, MD* Steven C. Hall, MD[dagger] Departments of Anesthesia; * Harvard Medical School; Children's Hospital; Boston, MA 02115-5735 [dagger] Northwestern University Medical School; Children's Memorial Hospital; Chicago, IL