Medical Transcript

Anesthesiology: The Silent Service

It’s the last face a patient is likely to see before the lights go out for surgery—the anesthesiologist. Last fall the School of Medicine made a tremendous commitment to its Department of Anesthesiology by recruiting one of the top professionals in the field as its chair. David Lubarsky, M.D., M.B.A., is a specialist in vascular, cardiac, and high-risk anesthesiology. He joined the University of Miami following a highly successful tenure at Duke University Medical Center, where he was professor and vice chairman of the Department of Anesthesiology and chief of the Division of General, Vascular, Transplant Anesthesia, and Critical Care Medicine. A proponent of applying industrial management science to patient care, Lubarsky taught at Duke’s Fuqua School of Business, focusing on informatics, the Internet, and health care. He also chaired the editorial board for AnesthesiaWeb (, the world’s most heavily subscribed anesthesiology
        Lubarsky discussed the dramatically changing field of anesthesiology and his plans for the department with Jerry Lewis, assistant vice president for communication at the School of Medicine.

JL Anesthesiologists in private practice make a lot of money. Why did you choose academia?
DL I did go into private practice—for a grand total of three weeks about ten years ago. And you’re right. I made more money in those three weeks than I did in four months as a member of the faculty at Duke. But just doing without teaching and just practicing without thinking every day about how to advance the field wasn’t for me. I’m a high-energy guy, and I can honestly say that I’ve been challenged and excited every single day of my 20 years within an academic medical center.
    It was that experience in private practice, though, that got me interested in the economics of health care. It also inspired me to help Duke’s anesthesia department do a better job of running the business of medicine, making more economic resources available to support academic anesthesia and the highly advanced care we sought to provide.
JL Is that why you—like other faculty who recently have been recruited to UM—decided to pursue an M.B.A. in addition to your M.D. degree?
DL Yes. I came to the realization that medicine is a business, but that the business should not run the doctors. When the business drives the physicians—instead of the other way around—the quality of care can be compromised. There are too many constraints in trying to streamline the process of health care without understanding patient care. And there are too few physicians who are able to direct and implement improvements in very complex and expensive academic medical centers.
    I hope to be someone who can help the University of Miami thrive in Florida’s competitive health care market, but to temper the business imperatives by always making sure, as an academic physician, that we never compromise care as a more profit-oriented medical center might. Better health care is not cheaper health care. Excellent health care is just like any other high-quality product. It’s something worth paying for. And it’s something society will pay for.
JL How did you get involved in the field of anesthesiology?
DL I chose anesthesiology because I loved physiology and pharmacology. Anesthesia is typically a relatively short and intense encounter with clearly defined parameters. While you’re with a patient, he or she has 100 percent of your care. That kind of focus appealed to me. As the field has evolved, though, anesthesiologists’ contributions have a larger impact—better patient preparation for surgery, more connections between what we do intraoperatively and postoperatively, beyond the initial few hours’ recovery period.
JL What’s new in the field?
DL I can now say with greater confidence that anesthesia is safe. That wasn’t necessarily the case even just ten years ago. Across the nation, malpractice ratings went from highest to lowest in the medical community almost overnight.
    Anesthesiologists are now using different “agents” and can manipulate them much better. We are concentrating on things like increasing the comfort of our patients, who should always be first and foremost in all that we do. We have made tremendous strides in alleviating nausea and controlling pain.
JL Is this a good time to enter the field?
DL Absolutely. The future of anesthesiology has never been brighter or more exciting. As progressively sicker individuals are considered candidates for lifesaving surgery, anesthesiologists must know—and continue to learn throughout their career—about cardiology, pulmonary medicine, critical care, and advanced pain management.
    Excellent anesthesiologist-directed medical management is being recognized as critical to a good surgical outcome and is constantly being improved by our input. Collaboration with and recognition of our value by our surgical colleagues is at an all-time high. Anesthesiology is a wide-ranging practice of medicine, and well-trained physician/anesthesiologists are more important than ever to good surgical outcomes.
    One of the most exciting areas is pain management. I’d like to see a comprehensive pain management program at the School of Medicine, and I expect that anesthesiologists will play a critical leadership role.
JL Where are you putting your energy and resources early on?
DL The residency program is my primary focus for the first two years. Our program requires a greater number of excellent faculty to complement the fine individuals already on staff, as well as the addition of 21st-century training resources. I’m here to build the program to its full potential. Every patient should receive state-of-the-art perioperative anesthesiology. This requires training anesthesiologists who will be progressive, state-of-the-art practitioners ten and 20 years from now.
    One thing I want to do immediately is to get a simulation lab up and running and fully integrated into the training curriculum. I feel strongly that every resident should master and pass a simulator test in crisis management before being sent out to practice.
    We also will be developing a sophisticated computer-based library so that, no matter where a trainee is and no matter what time of day it is, the absolute latest reference material will be available to help our physicians provide the best care possible.

JL How does our residency program compare to others around the country?
DL There definitely is room for improvement. Right now, one of my top priorities is to recruit the very best students we can get. We also need a few mentor-level faculty members who can help boost our students’ test scores on board exams. One way we’ll do this is to expand the faculty and reduce the number of residents, thus improving the ratio of faculty to trainees. Then we’ll build back up. One of my specialties is tutoring physicians to pass the board exams. I’ve written three books on the subject, which have been fairly successful, and have been recruited by British colleagues to produce a similar training guide for the English exam system. I’m certain that with a little focused attention on this, and a higher level of expectation on the department’s part, the residency program soon will be considered one of the nation’s finest. Our department will not settle for anything less.
JL How does the Department of Anesthesiology factor in with the School of Medicine’s major emphasis on externally funded research, specifically from the National Institutes of Health?
DL Anesthesia, in general, ranks near the bottom in terms of funds available from the NIH. There are some clinical research funds available from the NIH, though. One of my challenges will be to attract our fair share, and then some.
    A tremendous success of the Duke anesthesiology program was that we moved from 23rd in NIH funding to No. 3 over a span of only eight years. It’s all a matter of strategy, focus, and investment in the right faculty.

Photography: by John Zillioux
University of Miami Medicine Online
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