ASA 2004-2013: Representing, Supporting, Educating in the Face of Increasing Regulatory Burdens

The period from 2004 to 2013 was a transformative decade for the Australian Society of Anaesthetists (ASA). Although the crises of runaway medical indemnity costs and indemnifier instability were addressed, the era was marked by significant political instability. This instability was reflected in the rapid turnover of leadership, with five Prime Ministers and four Federal Health Ministers over ten years, each bringing different plans and perspectives on healthcare.

Navigating Regulatory Waters

In response to the increasing regulatory burdens, the ASA made numerous submissions to both government and non-government agencies. These included addressing the Australian Commission on Safety and Quality in Health Care (ACSQHC) and its various standards, contributing to the Productivity Commission’s report on Australia’s health workforce in 2006, and engaging with the National Health Workforce Taskforce established the same year. The ASA also responded to the National Registration and Accreditation Scheme (NRAS), which commenced on 1 July 2010, and addressed issues such as “mandatory notification,” “Lead Clinicians Groups,” and “Improving Maternity Services in Australia.” Additionally, the ASA engaged with the Independent Hospital Pricing Authority and vocational training in the private sector.

Building a Stronger Anaesthesia Workforce

The rapid growth of the medical workforce, and by extension, the anaesthesia workforce, raised concerns among ASA members. These concerns centred on the potential hindrance to the consolidation of skills for new specialists and the risk of deskilling among more senior anaesthetists. Over the decade, the number of medical graduates more than doubled from 1,300 to 3,100 annually, the number of vocational trainees in anaesthesia increased to about 1,200, and the total number of specialist anaesthetists grew by 40% to approximately 4,200.

The ASA made submissions to the Productivity Commission, which reported on Australia’s health workforce in 2006. The report canvassed “task substitution,” and the issue of “non-medical anaesthesia providers” became a major point of discussion. Numerous workforce studies were conducted by the ASA and other agencies. An ASA and Australian and New Zealand College of Anaesthetists (ANZCA) Joint Workforce Study in 2008 yielded different interpretations of the findings. A 2013 ASA survey revealed that two-thirds of both younger and established anaesthetists believed that too many anaesthetists were being trained. In response, the ASA hosted a Workforce Summit with ANZCA, the New Zealand Society of Anaesthetists (NZSA), and the Australian Medical Association (AMA) on 7 December 2013, advocating the position that the anaesthesia workforce was oversupplied but maldistributed. Health Workforce Australia’s report “HW2025” also had significant implications for Australian anaesthetists. The Medical Training Review Panel’s (MTRP) 16th report found that the number of vocational medical trainees had increased by 250% since 2000, suggesting an oversupply in anaesthesia compounded by an influx of overseas-trained specialists.

Economic Empowerment

The ASA vigorously supported its members in the economic sphere during this decade. Following ASA advocacy, new anaesthesia items were introduced into the Medicare Benefits Schedule (MBS) for “in-room consultation.” Department of Veterans’ Affairs (DVA) payments were increased and aligned with the Private Health Insurers’ RVG schedules, and considerable increases in WorkCover payments were achieved. Informed Financial Consent became the norm, and an Informed Financial Consent Campaign was conducted by the ASA. After first recommending the RVG system in 1987, the ASA saw its adoption into the Government’s MBS, appearing in that publication on 1 November 2001.

Professional Advocacy

In 2005, the Professional Issues Advisory Committee (PIAC) was established to advise the ASA Council on the expanding range of professional issues. From 2005, there were discussions about changing the specialty’s name from “anaesthesia” to “anaesthesiology” and the practitioner’s title from “anaesthetist” to “anaesthesiologist.” Ultimately, the ASA decided to retain the term “anaesthetists.”

The ASA also provided input on “Good Medical Practice: A Code of Conduct for Doctors,” published by the Medical Board of Australia in November 2009, and endorsed the World Health Organization Surgical Safety Checklist in 2009. The ASA PhD Support Grants were also created in 2005 to assist member researchers.

Setting Standards

A Code of Conduct for ASA members was formulated in 2005. Position Statements were introduced and regularly reviewed to help members navigate an evolving professional environment. Iamonline modules were created to leverage online learning. The ASA, ANZCA, and NZSA established the Australian and New Zealand Tripartite Anaesthesia Data Committee (ANZTADC) to collect anaesthesia critical incidents online, with 2,468 incidents submitted and preliminary analysis performed as of 12 June 2014.

ASA’s Evolution

During this decade, the ASA underwent significant evolution and expansion. “Anaesthesia and Intensive Care” journal celebrated its fourth decade of publication and became the flagship journal for both the Australian and New Zealand Intensive Care Society (ANZICS) and NZSA. In 2012, “Australian Anaesthetist” magazine took over from ASA News, reinforcing the ASA’s pivotal role as a leading advocate and resource hub for anaesthetists across Australia, with a clear emphasis on serving its members.

Membership numbers saw a notable increase during this period, reflecting growing recognition and support among anaesthetists nationwide. The ASA also embarked on impactful initiatives such as the Global Oximetry Project in 2010, a collaborative effort with the World Federation of Societies of Anaesthesiologists (WFSA) and the ASA’s Overseas Development and Education Committee (ODEC) to advance global standards in patient care.

Leadership changes were notable, with Executive Director Peter Lawrence retiring after nine years and Mark Carmichael assuming the role of CEO on 23 April 2012. D. Michael Tuch’s tenure as Treasurer ended in 2012, marking a transition in key leadership positions. The Secretariat’s growth necessitated a relocation to 121 Walker Street, North Sydney, in February 2013, underscoring the ASA’s expanding operational footprint.

Throughout this period, the ASA continued to enhance its educational and professional offerings. The 8th International Symposium on the History of Anaesthesia in 2013 at the University of Sydney highlighted ongoing academic engagement and recognition within the field. The National Scientific Congress evolved in format, emphasising the anaesthetist’s role as a perioperative physician, while communication workshops and online resources further supported members’ professional development and patient care.

As the ASA strengthened its global ties, members actively participated in WFSA World Congresses in Paris (2004), Cape Town (2008), and Buenos Aires (2012), demonstrating a commitment to international collaboration and advancing anaesthesia practices worldwide. These initiatives underscored the ASA’s pivotal role in shaping the future of anaesthesia and intensive care both locally and globally.

This decade was marked by significant regulatory, workforce, and economic challenges. The ASA’s proactive and multifaceted approach ensured that it remained a strong advocate for its members while adapting to an evolving healthcare landscape.