4/1/2017
Professional Citizenship
AAAA Annual Meeting
Austin, Texas
April 1, 2017
COI Disclosure
• No conflicts
JEFFREY S. PLAGENHOEF, MD
ASA PRESIDENT
CHAIRMAN, BAYLOR SCOTT & WHITE HILLCREST MED CTR
Learning Objectives
1. Discuss Professional Citizenship in terms of definition
and behavior.
2. Create a personal plan for elevation of professional
citizenship levels for themselves and their partners.
3. Convey to other AAs why they too have an obligation to
do all that is necessary to protect patients and our
specialties in today’s hostile environment.
4. Speak to the value of the ASA and AAAA to all Students
and Fellows of the Academy.
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What is ASA doing for AAs and SAAs?
*** 2017 Top Focus Items ***
o AA Training Programs
o AA Licensure
o Committee on AA Ed and Practice
o Scope of Practice Expansion
o APRN CM (VANH) and Compact
o Insurance Gaps & OONB
o ACA R&R
o Payment Models/MACRA
o PSH
o Quality Measure Development
o AQI/NACOR
o Pediatric Dental Anesthesia
o Patients Bill of Rights
o PR and marketing
*If not ASA and AAA,
then who?
*If not you, then who?
*Whose responsibility?
“The future ain’t what it used to be.”
Always Know Who is Offering Advice
• Kalamazoo, MI, 1960
• Plainwell, MI – pop. 4,000!
• MSU  MCG  UAB (‘88-’91)
• Dothan, AL 1991 – 2015
• Waco, TX - July, 2015,
• With no preparation, I jumped in 1995 &
the journey began!
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Definitions of Professionalism
Definitions
• The conduct, aims, or qualities that characterize or
mark a profession or a professional
Professionalism
• The methods, characteristics, and attitudes of a
person holding a job that requires higher education
or advanced training
Vs.
Professional Citizenship
• The combination of all of the qualities that are
connected with trained and skilled people
• The methods, character, status, etc. of a
professional
What’s in Your Personal Profile?
• Honesty
• Leadership
• Neat Appearance
• Proper Conduct
• QI Efforts
• Trust
• Integrity
• Availability
• Ethical Behavior
• Accountability
• Courtesy
• Responsibility
• Compassion
• Altruism
• Collaboration
• Ownership
• Highest standards
Trust
“The intuitive confidence and sense of comfort that
comes from the belief that we can rely on a person
or organization without thinking about it – we
simply know we can trust them”
“Trust Matters”
Dan S. Wilford
Michael H. Annison
• Innovative
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Professionalism
ASA Newsletter September
2003
Volume 67, Number 9
What is “Professional Citizenship”?
• At its core, a willingness to accept responsibility and ownership
for the present and future state of “X”
• Team player
• Pulling your fair share of the load - ALWAYS
• Leading by example – in EVERYTHING!
• Standing up for and doing what is right – ALWAYS!
• Not just taking – but at all levels GIVING BACK
• Supporting the mission with YOUR time, energy and money
Defining Professionalism
• “My difficulty in defining professionalism has similarities
to a 1964 U.S. Supreme Court decision
Norig Ellison, MD,
ASA Pres ‘96
• “I shall not today attempt to further define obscenity,
but I know it when I see it!”
SCOTUS Justice Potter Stewart
ACGME Requirements
Professional responsibilities defined by The Charter on Professionalism
• Commitment to professional competence
• Commitment to honesty with patients
• Commitment to patient confidentiality
• Commitment to maintaining appropriate relations with patients
• Commitment to improving quality care
• Commitment to improving access to care
• Commitment to a just distribution of finite resources
• Commitment to scientific knowledge
• Commitment to maintaining trust by managing conflicts of interest
• Commitment to professional responsibilities
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“Active Citizenship”
• Assertion that members of companies or nationstates have certain roles and responsibilities at a
higher level than their primary job
• Societally, easier to define “rights” than
“responsibilities”
Is Doing Your Primary Job Enough?
Always do your best at what’s
expected of you… and then some!
• Active citizens - fulfill both rights and
responsibilities in a balanced way (simple
distillation = take & give back)
So, why discuss this?
1) Your future truly depends upon a transformation from
within
2) We all have too many takers and not enough givers!
3) Not everyone had good parents –
missed out on “The Dad/Mom Talk”!
4) Solid professional citizenship can readily be taught through
effective leadership and mentorship
Teaching Professionalism
• Set expectations – policies
*Must include consequences of noncompliance*
• Assess compliance and performance
• Reward good behavior, remediate inappropriate
• Goals - preventing inappropriate behaviors and
implementing a cultural change.
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But, does teaching professionalism do any good?
• Certain behaviors early in medical education have
been found to correlate with unprofessional
behavior later in careers.
• We need to be vigilant in looking for those
behaviors and let our students and trainees know
why we're so concerned about them.
But what else do I know how to do?
Teach who?
• Students, of course, but also Fellows
• Mentorship – not just clinically, but also in professional
citizenship
• All seasoned department/group members should
play a leadership role in mentoring others
• However, younger and less experienced can “school” the old
folks and the dead wood!
Opportunity for Professional Service
Abound at all Levels
• Just start doing something. Get your hands wet – there’s
tons to do!
• Group/department Level
• Remember the 20/80 rule. Be a leader, not a follower. Be
“a giver” and not “a taker.”
• County Level
• No decent leader will say “no” to your offer to help do
something just because you lack experience
• We all know some microbiology – in those terms, don’t be
a parasite!
• Institutional Level
• City Level
• State Level
• National Level
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Opportunity for Professional Service
Abound in Multiple Areas
• Practice Leadership
• Department Leadership
$ Basic Financial Metrics $
Learn them!
• Committee work at ALL levels
• Financial
• QA – Individual projects to quality reporting
• IT – EMR/AIMS
• Legislative
Must understand at least basic financial
considerations to strengthen alignment
Read!
There are hundreds of very helpful books, but
some are must reads.
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When it comes to organized medicine,
please NEVER say…
• “The AAAA needs to do this, that or the other”
• “The ASA needs to do X, Y or Z…”
• And for sure do not ever prove your consummate
ignorance by saying…
“The AAAA and ASA don’t really
do anything for me”
Come on… Really?
Professional Societies = Volunteer Organizations
• What professional societies do - and do not do - is up
to each of us. We are all, responsible for either
weakness or strength.
• How dare anybody contributing less to the greater
good say that someone doing more should do even
more.
Volunteer Organizations
*A challenge of common views*
“Well you like to do that stuff”… grrrr!
• So don’t fret, don’t complain, don’t be aloof – please
step up and volunteer to do something constructive
to contribute to the greater good
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*Advocacy*
A Huge, Equally Shared Responsibility
Definition: noun – recommendation, support, defense,
championing, backing, proposal, urging, promotion,
campaigning for, upholding, encouragement, justification,
advancement, pleading for, propagation, espousal,
promulgation, boosterism, spokesmanship
Why the Strongest Advocacy Possible
is Essential to Your Future
• MACRA - Payment paradigms totally remodeled
• Quality reporting demands
• Meaningful Use
• APRN Consensus Model – AANA and rest of organized nursing
• “Poachers and Dabblers”
• Chronicity of APATHY and COMPLACENCY
• Money is getting tighter and tighter
• Do you have a seat at the right tables? The horizon is being painted,
but will we all have brushes in our hands?
“We’ve met the enemy and he is us!” (Pogo)
Walt Kelly (1913-1973), author of Pogo
• 1813 – U. S. Navy Commodore to Army General ” We have met the enemy , and they are ours.”
Edited by Kelly for this 1970 Earth Day
poster addressing pollution.
• The Pogo Papers (1953) “… I attempted to explain
each individual is wholly involved in the democratic
process, work at it or not. The results of the process
fall on the head of the public, and he who is
recalcitrant or procrastinates in raising his voice can
blame no one but himself… Resolve, then, that on this
very ground… we shall meet the enemy, and not only
may he be ours, he may be us.”
• 1970 Earth Day Poster...
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Pogo Covers
School of Pharmacy
University of Maryland
• INSTRUCTIONAL DESIGN AND ASSESSMENT
Effective Leadership and Advocacy: Amplifying
Professional Citizenship
Cynthia J. Boyle, PharmD, Robert S. Beardsley, PhD, and Margaret Hayes,
American Journal of Pharmaceutical Education 2004; 68 (3) Article 63.
Their Introduction…
“The profession of pharmacy (AAs) is governed by legislation
and regulations that are constantly changing. By bringing
their expertise as medication specialists into legislative and
regulatory negotiations, pharmacists (AAs) can influence
decisions to promote safe and effective health care policy and
delivery. Therefore, it is important for student pharmacists
(SAAs) to develop leadership and expertise in advocacy, as they
meet the Accreditation Council for Pharmacy Education
curricular outcomes for the doctor of pharmacy degree….”
MS;
Cont’d…
“… as part of this professional citizenship,
pharmacists must intervene for patients and
communicate with individuals and groups that are
not health professionals, such as managers,
legislators, payers, and society at large.”
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If you want us to have a seat at the
table – help make the reservation!
“ The more AAs take part in government,
the less government will take a part of AAs.”
Bi-partisan & non-ideological political voice of the ASA.
Founded in 1991 to advocate political issues on behalf
of ALL anesthesiologists and their patients.
Why ASAPAC?
• A “Plagenhoefism” – politicians’ hearing aides.
• It is the way politics is played in the U.S., and we cannot
win a game without playing in it.
• One cannot talk about healthcare delivery today without
including advocacy – it is crucial to all that is patient
safety, quality of care and our businesses.
• Basic entry level professional citizenship is expected of
everyone!!!
• NOT taxation without representation!!!
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AAAA’s ASAPAC Support History
Fiscal Year
Total Raised by
AAs
2010
$12,637.00
2012
2014
2009
2011
2013
2015
ASA 2015
Nat’l Avg. 45
Total # of
Contributors
% Contributing
ASA Memb. Total
67
20.60%
326
$26,553.00
276
37.70%
733
$27,895.00
279
29.70%
939
$7,135.00
$18,227.50
$26,705.00
$29,295.00
29
103
262
294
9.70%
17.80%
36.20%
33.90%
21%
Average Contrib.
298
$246
578
$177
723
923
© 2015 AMERICAN
SOCIETY OF
ANESTHESIOLOGIST
S.
$189
$96
$102
CWRU (Cleveland, Houston, DC), UMKC
• 2014 AA Programs at 100%
CWRU (Cleveland, Houston, DC), UMKC
• All S-AAs expected to give $20 annually to ASAPAC
• Goal: 100% of AAs support ASAPAC EVERY year
• American Academy of Anesthesiologist Assistant (AAAA)
$100
$249
CWRU (Cleveland, Houston, DC), UMKC, South University, Nova Ft
Lauderdale
• 2013 AA Programs at 100%
• All SAAs expected to be taught about the crucial value of
advocacy for our patients and our medical specialty
$100
ASA Alabama Cup
“Student AA Competition”
• 2012 AA Programs at 100%
ASA Alabama Cup
“Student AA Competition”
VA’s PROPOSED New Nursing Handbook 
 is now the VHA Final Rule!
Clear demonstration that professional citizenship is
an absolute essential requirement if we are to
execute effectively in the current world.
• 2015 AA Programs at 100%
CWRU (Cleveland, Houston, DC), UMKC
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*The Final Rule
Veterans Affairs Update
VETERANS WON!
*More important now than ever – not
just impact within VAHA!
50
AA Training Programs’
VANH Responses
Program
Completed
• Program
Case W, Cleveland
Completed Total
• Case DC
Case W, Houston
21
8
• Emory
Nova Southeastern
45
23 73
Case W, DC
•
Case Cleveland
Emory
•
Case Houston
9
Quinnipiac
UMKC
•
Quinnipiac
•
40.90
45 8
20
40
145
15.86
29
13
0
72.41
61.64
45
36
36.11
0
5
11 11
University of Colorado
Students w/out• program
Unlisted Program 34 34
listed
TOTALS
Total
22
• South University
U of MO Kansas
City
13 22
•
Percentage
21 9
• Nova Southeastern
South University
22 23
U of Colorado
AANA and NA’s Response to ASA Safe VA Care Initiative
186
20
101
48.89
Percentage
22
41%
20
40%
145
16%
36
36%
29
73
45
72%
62%
49%
55
20
55%
33.66%
101
34%
496
38%
0
5
O%
Based on AAAA’s academic program records
*Important Questions*
1)Whose feelings should be hurt?
2) Whose national association has been critical of and
disrespectful to the other providers?
3) Who is offended by whom?
4) Who started this?
5) Who tried to kick whom off the Anesthesia Care
Team (ACT)?
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Anesthesiologist Assistant Programs
• Emory University- 1969
• Case Western Reserve University-Cleveland- 1970
• South University- 2004
• Nova Southeastern University Ft Lauderdale- 2005
• University Missouri Kansas City- 2008
• Nova Southeastern University Tampa- 2009
• Case Western Reserve University- Houston- 2010
• Case Western Reserve University- DC- 2012
• University of Colorado- 2013
• Quinnipiac University-2013
• Medical College of Wisconsin-2016
My 2016 Stated Goals for you during my ASA
Presidency
• Surpass your 36.7% ASAPAC support rate
• All AA training programs at 100% 2016,
2017 and 2018
• All AA training programs at 100% on VANH
“1+5 Plan”
• I’ll be back!!!
Austin 2017!
Our Messaging – Super Important!
• DO NOT avoid conflict and contentious discussions –
embrace them
• Focus attention on which side is honestly most offensive
• Do not cover up the truth
• See dues paying and AANA PAC supporting for what
they are – supportive of the messaging that you don’t
matter
• The paradigm will not be changed without each of you
being bold!!!
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What do your “optics” need to display in order for
the AA profession to have the brightest future?
• Professionalism among all of you and in all that you do.
• Professional Citizenship demonstrated
• Unity with physician anesthesiologists and the ASA
• Easiest ways to demonstrate that – membership and advocacy support
• You believe in the value of physician leadership of the ACT
• You are better than nurses who do similar work
GIVE
• Your Time
• Your Effort
• Your Money – the easiest contribution!
• How to kill the AA profession over a short time?
OR… at least serve as supporting cast
• A HUGE opportunity that any AA that
wants to be a part of the solution can
do.
Lots of change on the horizon!
• Talk about this in your group.
• “The Legacy of Gopal”
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Don’t put your head in the sand.
Is Doing Just Your Primary Job Enough?
Do your best at what’s expected of you…”And
then some!”
Engagement and support is VITAL to our future!
“History will be kind to me
for I intend to write it.”
Winston Churchill
What are your personal plans for individual effort
to address these threats and challenges?
o We should all be thankful for volunteerism
o We should all be thankful for the ASA and the AAAA and
ALL AAs should support both.
o There is definitely strong membership value proposition for
membership in ASA and AAAA
Selling membership value proposition should be very easy when
put into the framework of threats and challenges
Will YOU be helping to write the future history of your specialty???
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Increase Your “Draft Value”
Look beyond just being a great clinical AA – be a leader in all that you
do. Protecting patients, quality and safety is NOBODY ELSES
responsibility any more than it is your own!
Up your game, lead, and be the one
that transforms change into
opportunity for improvement.
D ON ’T EXPECT OTHERS TO D O THE WORK FOR YOU
“Example is not the MAIN thing in
influencing others - it is the ONLY
thing!” ALBERT SCHWEITZER
“The world will not be destroyed by
those who do evil, but by those who
watch them and do nothing.”
EINSTEIN
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Applied to Current Events…
Plagenhoef’s Corollary
“Patient safety and anesthesiology will not be
destroyed by those unaware of the differences
between nurses and physicians, but by those totally
aware - through education and experience - who
watch them and elect to say or do nothing to lead in
the right direction.”
Contact Info
Jeff Plagenhoef
[email protected]
Cell: (334) 790-9648
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