My opinion

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I am deciding to not wait for my early/normal/late and forced/unforced retirement to ask the question [1] which may heal anesthesiology, the Fisher King. The healing question "Whom does the Grail serve?" [2] has been and will always be wide open to interpretations depending on who, why, when and where. For me as a young full-time anesthesiologist in the United States, that Grail is the science and art of anesthesia and analgesia and the time to ask the healing question is right now when wartime approach to pandemic is meddling with physician exceptionalism [3] and non-physicians' delimited scope of practice [4].

• Does the Grail serve patients who look up to good outcomes for themselves?
• Does the Grail serve payers who look up to cost-effective outcomes among patients?
• Does the Grail serve providers who look up to livelihood-supporting reimbursements for patient care?
• Does the Grail serve regulators who look up to socioeconomically viable healthcare delivered by payers and providers?

Being an anesthesiologist myself who may have conflict of interest while seeking answer to the healing question, I will just pose questions as pertaining to current and future medically directing anesthesiologists.

• Has the evolved Grail become mature enough to allow non-physicians safely flying solo without the oversight by anesthesiologists who have superiorly famed degrees, longer training durations and higher student loans-debts?
• Has the matured Grail equalized the anesthesia providers in terms of minimum basic skills demonstrated by them to safely and cost-effectively provide anesthesia care for supermajority of diagnostic and therapeutic surgeries and interventional procedures?
• Has the safe-skilled Grail limited the need for extra-pair of hands to some occasions, extra-set of eyes to few occasions and extra-mind to fewer occasions?
• Has the futuristic Grail been looking up to the evolution of medically directing anesthesiologists into medically supervising anesthesiologists to eventually medically consulting anesthesiologists?
• Has the visionary Grail envisioned humans or artificial intelligence as medically consulting anesthesiologists to provide elective or emergent 24x7 consultations via on-site presence and/or audiovisual support remotely [5]?
• Has the collaborative Grail been planning to coalesce anesthesia providers’ workforce by shedding redundant training period in the specialty as well as redundant personnel presence during the procedures so that the shortages within the subgroups of anesthesia providers turn into overall surplus of anesthesia providers once equalized within a unified workforce [6]?
• Has the equalizer Grail foretold the need to downsize and then eventually abort anesthesiology training programs to allow medical students' pursuit for alternative futures in the medicine rather than being born into a war-torn specialty which may never see the peacetime when despite unpredictable future, new soldiers have celebratory recruitment every year?
• Has the realistic Grail ever wondered whether the downsized or aborted anesthesiology training programs will have ripple effect on medical schools' enrollment and their tuitions in the United States unless the major loss may be limited to the debt-free international medical graduates whose opportunities to pursue graduate medical education in the United States may get restricted because their future recruitment opportunities within the unified anesthesia providers' workforce may become extremely limited?

The million-dollar questions are:

• Did systems-based practice of safer medicine dampen the charm of being a savior physician or being an enterprising anesthesiologist?
• Did protocols-based safely diagnosing and treating patients delimit physicians' humanity to just comforting the managed patients?
• Did teams-based workplace deem physicians overqualified per their medical degrees but under-qualified per their leadership skills?
• Did web-based socialized knowledge neutralize exceptionalism enjoyed by those matriculating to graduate with prestigious degrees?
• Did loans-based tuitions envisage that providers' bubble [7] is to unnecessary procedures as litigators' bubble [8] is to unnecessary litigations?

Going forward, the futuristic existential questions are:

• Will anesthesiology consultancy model be vibrant enough to meet elective and emergent needs of equalized and unified anesthesia providers' workforce personally delivering anesthesia in the procedure rooms by being dynamically attuned to their first attempt success rates for invasive anesthesia procedures, call-for-help rates for extra-hands/eyes/mind, and anesthesia event rates with corresponding patient outcome rates?
• Will anesthesiology consultancy model create comfortable livelihood for full-time in-person medically consulting anesthesiologists unless they will have to supplement their earnings as part-time anesthesia providers personally delivering anesthesia in the procedure rooms and/or by expanding their reach of anesthesiology consultancy to provide remote peri-anesthesia support for anesthesia providers via privacy-compliant audiovisual gadgets and robots?
• Will anesthesiology consultancy model limit the liability of medically consulting anesthesiologists only as pertaining to their elective and emergent in-person or remote consultations?
• Will anesthesiology consultancy model create better revenue/reimbursement per medical consultation for medically consulting anesthesiologists than current revenue/reimbursement per medical supervision or direction?
• Will anesthesiology consultancy model eventually drive up the number of anesthetic procedures to sustain the equalized salaries of surplus anesthesia providers available in the unified workforce to personally deliver anesthesia in the procedure rooms unless, to accommodate paid work opportunities for all within the ballooned workforce, anesthesia providers voluntarily or mandatorily decide to uniformly limit their work-week to 40-hours thus allowing them more quality time for self and with family despite their smaller paychecks bringing them down from top 5% to top 10% in the United States [9]?
• Will anesthesiology consultancy model turn out to be an intentional self-harm event to heal anesthesiology, the Fisher King, by endorsing a well-informed and educated decision about managed contraception of anesthesiology as a medical specialty [10-11]?

Essentially, I am envisioning while fearing the fear itself that, in due course of time when sustainable future metamorphoses from delusional present, (a) some medically directing anesthesiologists may evolve into medically consulting anesthesiologists, (b) some medically directing anesthesiologists may teach full-time as academic anesthesiologists if anesthesia providers want to learn from them, (c) some medically directing anesthesiologists may explore as full-time research anesthesiologists if the society expects them to innovate, (d) some medically directing anesthesiologists may retire, (e) some medically directing anesthesiologists may emigrate from the specialty and/or the locality to greener pastures, and (f) some medically directing anesthesiologists may move back into the procedure rooms to personally deliver anesthesia. Only time will tell whether modern artists will continue to be nurtured by modern technological societies just like ancient artists had been nurtured by ancient hunter-gatherer societies because without nurturing ancient artists who were allowed and expected to neither hunt nor gather [12], ancient hunter-gatherer societies would not have evolved into modern technological societies due to the escalated evolution of humanity as wired in the culture [13] by the non-hunting non-gathering visionaries.

Reference(s)

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1. Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. https://www.ama zon.com/Saving-Normal-Out-Control-Medicalization/dp/0062229265
2. The Legend of the Holy Grail Gallery. www.bbc.co.uk/history/british/hg_gal lery_01.shtml
3. The Problematic Virtue of Physician Exceptionalism. https://etd.library.emory.edu/concern/et ds/bz60cx10m
4. Relaxed Direct Physician Supervision Requirements During The COVID-19 Pandemic. https://www.jds upra.com/legalnews/relaxed-direct-physician-supervision-12685/
5. House Bill 4359 passed the Michigan Senate. https:/ /www.msms.org/About-MSMS/News-Media/house-bill-4359-passed-the-michigan-senate
6. Is There a Shortage of Anesthesia Providers in the United States? https://www.rand.org/pubs/research_brie fs/RB9541.html
7. The Problem with U.S. Health Care Isn’t a Shortage of Doctors. https://h br.org/2020/03/the-problem-with-u-s-health-care-isnt-a-shortage-of-doctors
8. The Lawyer Bubble: A Profession in Crisis. https://www.amazon.com/L awyer-Bubble-Profession-Crisis/dp/0465065597
9. How Much Income Puts You in the Top 1%, 5%, 10%? https://ww w.investopedia.com/personal-finance/how-much-income-puts-you-top-1-5-10/
10. Artificial Intelligence And Redundant Specialties. www.webmedcentral.com/article_view/5605  
11. The Legend of Kalidasa Inspiring To Phase Out Overspecialization: Skills vs. Degrees. www.webmedcentral.com/article_view/5644
12. Human Tribalism: A Curse of Our Evolutionary Past? | Gifford Lectures 2019 | Prof Mark Pagel | Pt 3. https://www.youtube.com/watch?v=pBPpi RP8NQw&t=3737s
13. Wired for Culture: Origins of the Human Social Mind. https://www.amazon.co m/Wired-Culture-Origins-Human-Social/dp/0393344207

Source(s) of Funding

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NOT APPLICABLE

Competing Interests

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NOT APPLICABLE