FUTURE DIRECTIONS

Predicting the future is a hazardous business. It is safe to say that the period until the publication of the next edition of this book will be just as tumultuous and challenging for the specialty as the period since the last edition.

The Department of Health and Human Services reported that health care spending for 2002 increased 9.3% to a total of $1.55 trillion, 15% of the GDP. And this is before the baby boomers reach Medicare age!^[56] Presumably, this will exert further downward influence on patient insurance benefits as well as on physician payment. This—along with continued technological advances, including the development of more rapid-acting, easily controllable, and reversible drugs, more reliable monitoring equipment, and newer less invasive surgical procedures—will mandate review of optimal methods for the delivery of anesthesia care.

In Europe, training schemes for non-physicians vary from as little as one year (for advanced nurses) to supervision ratios as high as 1:6. Are such situations as safe as our current practice? If so, should our role as rescue physicians be expanded? The role of the anesthesiologist in providing moderate sedation will most certainly be reviewed when the issue of "medical necessity" again is posed. Why is an anesthesiologist needed for colonoscopy procedures in New York but not in Iowa City? (Medicare reports a $50 million or 50% increase in this anesthesia code in 2002.) We need to define the best role for ourselves as physicians with unique skill sets.