To most of the general populace, anesthesiology is a mystery. Asking around, an anesthesiologist’s job is crudely equated to that of a boxer – earning an income on knocking people out. Although there exists the common stereotype that a good anesthesiologist requires no extrinsic gratitude or appreciation, over the course of a career, it can be quite frustrating at times to not be better understood by patients or colleagues. How exactly can we remedy this problem?

“As a logical consequence of becoming more competitive, the field is attracting brighter minds and fostering further ingenuity. Whether cyclically or permanently, anesthesiology has quickly become the ‘talk of the town’ in medical trainee circles. Regardless, the discrepancy in perspective of anesthesiology between laypeople and medical professionals remains.”

To answer this question, we must first look at the developments over the past few decades in general anesthesia. It’s not the public’s fault that their view of anesthesia is seemingly elementary or one-dimensional – for much of the specialty’s history, the field was seen as being hyper focused on the elimination of pain during surgical procedures (J Invest Surg 2012;25:141-9). Only in the past 20 or so years has anesthesiology taken off in breadth, firing on all cylinders of patient management, from purposeful opioid use reduction, anxiety alleviation measures, feeding and ambulation encouragement, administration of antimicrobials, regional anesthetic utilization, and enhanced recovery after surgery, among many other nuanced interventions (Korean J Anesthesiol 2018;71:175-81). With this rapidly evolving field of the perioperative surgical home, it is understandable that the general public has not kept up with the broad array of tools at the anesthesiologist’s disposal. For those of us more involved in medicine, the story is a bit different.

The exciting advancements and expansion of the specialty have not gone unnoticed by the rising class of medical graduates. In the 2023 NRMP Match, anesthesia programs nationwide received roughly 2,900 applications. Compare this statistic to its counterpart from 2019, where the total applicant pool numbered closer to 2,400 (asamonitor.pub/44HM57e). Clearly, the outlook is a positive one in the eyes of academic institutions affiliated with an anesthesiology program – more and more are flocking to this intellectually stimulating and rewarding specialty. As a logical consequence of becoming more competitive, the field is attracting brighter minds and fostering further ingenuity. Whether cyclically or permanently, anesthesiology has quickly become the “talk of the town” in medical trainee circles. Regardless, the discrepancy in perspective of anesthesiology between laypeople and medical professionals remains.

Resolving this disparity in viewpoint can be solved through simple education and advocacy. It is imperative for the welfare of patients and providers alike that the role of anesthesiologists in the medical realm be explicitly understood. Likely, a majority of us originally chose medicine to be an advocate for the community members we take care of. In a similar vein, the body of practicing and future anesthesiologists must also be advocates for themselves. Naturally, one might inquire why we need our importance to be made known. Is it not self-centered? As it stands, history has shown us that complacency in this regard will only lead to dire effects in the long term. In part to physicians being poor advocates for themselves, the public and Capitol Hill have sometimes been reluctant to side with anesthesiologists on maintenance of physician-based care and other impending issues. For example, significant time and resources are spent every year by ASA on state and federal advocacy initiatives, partly in an effort to sway policymakers’ opinions on proposals to remove anesthesiologists from the Anesthesia Care Team model and move to CRNA-only models of care. It begs the question: would we need this level of ASA engagement if the invaluable merit of an anesthesiologist was common knowledge? With a better baseline public understanding, perhaps something as simple as a conversation with a patient could change their (and their family’s) entire perception of the landscape of anesthesiology, paving the way for change, one mindset at a time.

In the meantime, our duty becomes embracing the challenge of educating society on perioperative patient safety matters, all the while improving quality of care and reaffirming our position as pivotal public servants (Can J Anaesth 2020;67:1493-6). This goal requires both recruitment of fresh minds into the specialty and ongoing active faces in the political sphere. The consistent upward trend of medical student interest in anesthesiology allows the discipline to step back and selectively handpick the leaders of tomorrow. In other words, the onus lands on our shoulders to ensure that the abounding influx of talent and drive does not go to waste. Without a political presence, we will be powerless in advocating for evidence-based, common-sense approaches to the practice of anesthesiology. Joining the ASA Grassroots Network, building connections with members of Congress, and taking action locally through fundraisers are all great methods to making a real, positive, meaningful impact on our colleagues’ and patients’ lives (asamonitor.pub/3nyws1v).

The tremendous value that an anesthesiologist brings to a health care setting must be acknowledged. Known as “the surgeon’s physician and the physician’s surgeon,” the anesthesiologist is a jack-of-all-trades whose poise in emergent scenarios quite literally saves lives (Anesth Essays Res 2015;9:293-7). It is up to us, physicians, residents, and students alike, to shape how the future of this specialty, and its care of vulnerable patients in their most stressful times, will continue. Gone are the days of the silent anesthesiologist working behind the scenes; it is time for the wizard behind the drape to be revealed.