Opportunities Beyond the Anesthesiology Department: Broader Impact Through Broader Thinking.

Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field's health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology's public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone-rather than the complex psychosocial milieu-for pain management. Due to the often episodic nature of anesthesiologists' interactions with patients, it remains challenging for anesthesiologists to achieve their full potential for broad impact and leadership within increasingly integrated health systems. To unlock this potential, anesthesiologists should cultivate new clinical, research, and administrative roles within the health system-transcending traditional missions, seeking interdepartmental collaborations, and taking measures to elevate anesthesiologists as dynamic and trusted leaders. This special article examines 3 core themes for how anesthesiologists can enhance their impact within the health care system and pursue new collaborative health missions with nonanesthesiologist clinicians, researchers, and administrative leaders. These themes include (1) reframing of traditional anesthesiologist missions toward a broader health system-wide context; (2) leveraging departmental and institutional support for professional career development; and (3) strategically prioritizing leadership attributes to enhance system-wide anesthesiologist contributions to improving overall patient health.

Academic medicine in turbulent times.

Long respected as centers of research and educational excellence, many traditional academic medical centers (AMCs) realize that their research and educational missions will be difficult if not impossible to sustain, if all the federal funding cuts discussed in anticipation of the "fiscal cliff" occur. To set the context for this perfect storm, we will review the many issues that will affect all hospitals and then focus on the three that will disproportionally affect academic medical centers ... and keep "CEOs up at night." Aside from a case of CEO chronic insomnia, how do we expect AMCs to weather this perfect storm? Whereas the fundamental emphasis remains on highly specialized and complex care, AMCs are increasingly developing innovative approaches for managing patients across the continuum of care and strengthening their ability to manage patients with high-cost, chronic conditions.

Enhancing the Value of Clinical Work-Choosing Wisely to Preserve the Clinician Workforce.

This Viewpoint discusses how to extend Choosing Wisely principles to identify clinical management practices that lead to unnecessary burdens, approaches to identify and prioritize those low-value practices, the partnerships needed to reduce burdens, and a research agenda for evaluating the consequences of change.