As anesthesiologists, we sometimes are reminded that much of the public and key stakeholders (executives, colleagues, legislators) are not aware that anesthesiologists are physicians. Consider the following three true stories.

  • While riding to the annual meeting in New Orleans last fall, an anesthesiologist strikes up a conversation with the driver. After learning his passenger is an anesthesiologist, the driver asks, “Is that a doctor?”
  • While riding to a component society meeting this spring, an anesthesiologist strikes up a conversation with the driver. After asking about anesthesiology, the driver asks, “Nurses can do that work too, right?”
  • While on a plane ride this past May, a passenger suddenly runs up the aisle yelling, “I need a doctor! My husband is sick!” An anesthesiologist who happens to be on the flight identifies himself and tends to her husband, who is dehydrated and nauseous. Fortunately, he experienced nothing life-threatening. The anesthesiologist waits for the couple to deplane after the flight. The woman, while very thankful for the anesthesiologist’s attention and caring, states, “I am sorry if I appeared upset – I was not sure you were a doctor.”

Reflecting upon these encounters, I am thankful for ASA’s strong and proactive communications and public relations strategies. ASA’s initiatives in this area have evolved from primarily public polling to a proactive, multipronged strategy, including podcasts and social media, that focuses on members, residents and medical students, the public, the press, legislators, and health care executives. This evolution in ASA’s communications strategy serves our members well and supports ASA’s work around advocacy, membership, and practice support.

So why am I, as ASA Treasurer, writing about communications?

ASA’s communications work is just one of a growing cohort of valuable initiatives that are important to achievement of our strategic goals and to securing the future. Over the past few years, our initiatives and programs have grown as ASA’s strategic goals related to quality and patient safety, payment and political advocacy, education, and practice management have evolved. Like our work in communications, all these initiatives are highly valued by most ASA members. Yet this growth carries costs. ASA neither can develop strategic plans without evaluation of financial impact nor manage finances without thoughtful consideration of strategic goals and member priorities. Strategic planning and financial strength are interdependent, and each informs the other.

ASA’s finances at present are sound. Our reserves remain strong, guided by thoughtful investment policies and disciplined expense management. Yet the sobering reality is that ASA’s operating expenses are outpacing its operating revenue, despite relative stability in the number of staff (Figure 1). Table 1 shows at a high level the components of ASA’s operating revenue and expenses.

Figure 1: 10-Year Trend of Revenues/Expenses/Head Count

Figure 1: 10-Year Trend of Revenues/Expenses/Head Count


At the time of this writing in June, ASA had conducted both its 2023 “4+8” and long-term forecasts. Some key details from each of those forecasts follow.

The 4+8 forecast includes four months of actual operating results and eight months of projections. Compared to the 2023 budget, the 4+8 forecasted an increase in the 2023 operating budget deficit from $1.2 million to $2.4 million. This deficit primarily was driven by broad decreases in revenue (corporate support, meetings, educational products, and membership dues) and ongoing uncertainty about the annual meeting. ASA leadership quickly took action to mitigate this risk and identified about $800,000 of savings in program expenses and deferred staff hirings, reducing the 2023 net operating deficit to $1.6 million – still $400,000 higher than budget.

The long-term forecast includes three years of projections. At present, our operating revenue is growing at a 0.6% annual rate, while our operating expenses are growing at a 1.5% annual rate. The forecast projects that, without any additional changes, ASA will encounter approximately $3 million in operating budget deficits in 2024, 2025, and 2026.

ASA leadership is committed to a long-term strategy that will maintain balanced operating budgets and support strategic goals. Annual operating deficits are not sustainable and would require ASA to liquidate long-term investments to meet its annual operational and programmatic needs.

One of ASA’s Strategic Pillars is “Stewardship of the Society and the Specialty.” A strategy within that pillar is: “Improve ASA’s position as an effective, well-run Medical Specialty Society that focuses upon financial performance, operational excellence, and resource utilization.”

In August 2022, the Board of Directors approved both a strategic revenue growth (SRG) fund and a Subcommittee on Strategic Revenue Growth, under the oversight of the Section on Fiscal Affairs. The subcommittee’s charge is to identify and develop programs that will generate nonmember, nondues revenue, with the first returns in that area anticipated in 2025. The Subcommittee on SRG continues to evaluate potential opportunities and is developing internal capability and external expertise to help ASA address this need (Table 2 shows the members of the Subcommittee on SRG). Of note, ASA Director of Hospital and Health System Business Development Mike Moran started on June 26, 2023, and we look forward to his work and expertise in this area.


Over time, the SRG will help ASA close the gap between operating revenue and expenses. To meet the needs and expectations of our members, though, we must do more than make incremental tweaks that may take years to mature and that do not address our underlying structural budget challenges: declining revenue from existing programs and inflation-driven increases in expenses. To address these operational deficits, ASA must act now, whether via revenue growth from existing products, an increase in membership dues, and/or targeted reductions in programmatic spending.

At its meeting in May, the Administrative Council approved the following statement:

“That the Section on Fiscal Affairs, in conjunction with the Committee on Membership, work to develop a strategic plan to address the risk of operating net income decrease through consideration of all options, including dues increases, programmatic cuts, and prioritization of spend; and to include benchmarking with other physician specialty societies.”

ASA President Michael Champeau, MD, FAAP, FASA, subsequently appointed an Ad Hoc Program and Resource Prioritization workgroup chaired by President-Elect Ron Harter, MD, FASA, to execute upon this directive. The workgroup’s goal is to draft a range of different gap plans, each including a different mix of revenue increase and expense reduction, that will address ASA’s structural operational budget deficits (Table 3 shows the members of this new ad hoc committee).


No one smiles at the thought of a dues increase. ASA’s last dues increase (3%) was in 2020, and leadership recognizes the sensitivity around this option. Our members are experiencing significant financial challenges at all levels: contract and fee-for-service payments, clinician compensation, and even CME benefits. While a dues increase may be warranted, ASA leaders cannot ask for that in a vacuum. Any request to increase dues must be accompanied by a plan to drive new revenue, eliminate costs by paring back or revising underperforming programs, and implement a consistent and rigorous process for prioritizing programs and initiatives.

At the time of this draft (June 2023), the Ad Hoc Program and Resource Prioritization workgroup is starting to review the current book of ASA programmatic spending, with the goal of prioritizing expenses based upon strategic importance, member satisfaction, and financial performance. The workgroup will develop a range of recommendations for review by the Administrative Council, Section on Fiscal Affairs, and, lastly, the Board of Directors at its August meeting.

As the health care ecosystem continues to evolve, our strategic initiatives undoubtedly will grow in both size and complexity. ASA’s financial review processes are evolving to meet the organization’s challenges through a realistic and honest lens. All our members should be confident that ASA leadership is addressing financial stewardship with transparency and foresight. That is what smart and strategic organizations do. The adoption of a consistent and regular process for reviewing our resource use, incorporating member priorities, is the necessary thing to do at this time.

ASA will always be a member-driven and member-governed organization. While our members may have different perceptions and practice models, all of us have much more in common with respect to shared strategic goals. ASA is the bond that unites and supports every anesthesiologist and helps all its members sustain a united front upon the key priorities of payment, physician-led anesthesiology care, and membership.

Any member should feel free to reach out to President Michael Champeau, President-Elect Ron Harter, or me with questions.

How do I know about those stories at the beginning of this article? I was the anesthesiologist in all three of them! And while it is possible I just had a stretch of bad luck, I would bet many of you have had similar experiences.

Of interest, the second driver told me he was getting married the following Saturday to a podiatrist in the area. I asked him to let his fiancée know that she could always rely on an anesthesiologist to help her provide her patients’ care.

One patient, one person at a time.