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 t’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 (www.anesthesiaweb.com),
the world’s most heavily subscribed anesthesiology
e-magazine.
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.
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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.
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