Chapter 2 - Scope of Modern Anesthetic Practice
Fredrick K. Orkin
Stephen J. Thomas
Since we last opined on the scope of anesthetic practice in the previous edition of this book, published in 1999, the specialty is experiencing a most e renewed interest among medical students and a spectacular increase in the demand for services. Nevertheless, many questions about our future, in terms of clinical practices and the best method for the delivery of anesthetic care and the education and research base for that practice have arisen. Politically the world, where now terrorism is feared in every land (see Chapter 64 ), has changed dramatically. The United States has endured September 11 and its aftermath. We have achieved remarkable military ess, invading both Afghanistan and Iraq, toppling and finally capturing Sadaam Hussein. The future plans for these countries remain somewhat vague, manifestly controversial, and incredibly costly. Medically, a crucial issue continues to be medical expenditures. The economy is recovering as the United States has plunged into record-setting deficits from equally impressive surpluses. The impact on federal expenditures to hospitals and clinicians as well as to scientists (the first rumors about the 2005 budget mention reductions in NIH funding) cannot be good. Scientifically, anesthesiology has joined other areas of medicine in the emphasis on e studies and on the potential of the new genomic treatment paradigm that promises to treat human disease according to the given patient's ic individuality.[1]
anization, financing, and delivery of health care continue to follow the whims of the marketplace. The defeat of the Clinton Health Plan a decade ago ushered in managed care—a cost-containment method of funding and delivering the "commodity" known as health care.[2] Despite spending almost 15% of the gross domestic product (GDP) on health care, we still managed to leave % of the population uninsured in 2004. Employer-supplied health
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