The Icarus Paradox and the Future of Anesthesiology

ANESTHESIOLOGY AT A DEAD END? The year is 2052. Within the perioperative services, an anesthesiologist remains a memory in the distant past. At the beginning of the century, anesthesiologists fought to demonstrate their value in a health care delivery system. From the perioperative surgical home (PSH) to quality improvement efforts, anesthesiologists tried to show that the clinical care that they delivered was superior. Emboldened by increasing hospital financial support brought about by ongoing provider shortages and focused instead on the perceived existential threat of scope of practice, anesthesiologists were completely blindsided by hospital system pivots to newer and more scalable technology-based anesthesia services. The inability to craft a universally acceptable narrative and continued balkanization with subspecialty fellowships undermined the clinical, research, and political missions of the specialty.1