MEET THE PRESIDENT

An Interview With SNACC’s New President Jeffrey J. Pasternak, MD

Jeffrey J. Pasternak, MD

Tell me a little about yourself aside from work.

I grew up in Elizabeth, New Jersey, in a bilingual home, although my Polish is now pretty rusty. Medicine is actually a second career for me. I have a Masters Degree in physical chemistry and worked in industry as a physical chemist for a few years before going to medical school. I will admit that I do miss laboratory research.

My wife Carole and I have been married since 1994. She is an attorney in private practice here in Rochester, Minnesota. We have two sons Carter and Andrew who are 18 and 15 years old, respectively.

In my spare time, I enjoy using the telescope that I have set up in my back yard. I also enjoy distance running, although my age is starting to catch up with me, and baseball (Go Minnesota Twins!…unless they are playing the New York Yankees...then Go Yankees!).

How do you feel about becoming president of SNACC?

This is an exhilarating and exciting opportunity. The role of president of SNACC is a very important job. The SNACC president, along with other members of the executive committee, board of directors, committees, the membership and SNACC’s management company can really drive the path of perioperative neuroscience. I am excited to have this opportunity to further contribute to SNACC and am ready to work hard.

I consider myself a creative thinker; however, I plan to use the full resources of the SNACC talent pool to introduce new ideas and vet those ideas, regardless of their origins.

I am also very humbled and a bit nervous. When I think about the reputations of the past presidents of SNACC, I am so impressed. However, theirs are “hard shoes to fill!”

What do you think will be the single biggest challenge for the specialty of neuroanesthesiology in the coming years?

That’s tough because I can think of many. However, I feel that the biggest challenge to our specialty is the recruitment, training, and support of the future generation of clinical and basic scientists with an interest in perioperative neuroscience.

In May 2017, at the Annual Meeting of the International Anesthesia Research Society, SNACC sponsored a convocation of neuroanesthesiology fellowship program directors and division chairs. This very topic, i.e., recruiting, encouraging, and training the next generation of contributors, was a core part of the discussions.

Recruitment into neuroanesthesiology and perioperative neuroscience should begin with medical students. Medical students with an interest in the nervous system usually seek out mentors and training programs in neurology, neurosurgery or psychiatry, but not anesthesiology. The foundation of the entire practice of anesthesiology is actually neuroscience. Currently, in our attempts to increase the size and talent of the perioperative neuroscience efforts, we seem to focus on recruiting anesthesiology residents into neuroanesthesiology when we should start to raise awareness for both anesthesiology and neuroanesthesiology among medical students.   

We also need think differently about marketing our subspecialty to trainees. Specifically, pain, regional, and cardiac anesthesia sell a “skill set” in terms of procedures (i.e., implantable stimulators, nerve blocks, echocardiography) and pediatric and OB anesthesia tend to play on people’s fears in that these fellowships sell skills to prepare trainees to deal with pediatric and obstetric crises. By comparison, fundamental basic science research is the core of neuroanesthesiology and that was something that I found so appealing about our subspecialty. However, instead of selling a “skill set” or playing on people’s concerns about complex cases (and their outcomes), I think that our specialty has stressed basic and clinical science research as the core of this field. I think that we should broaden our scope and sell neuroanesthesiology fellowships as a means to acquire the some of the following skills, to name a few: research, neurologic crisis management, nervous system monitoring, healthcare-delivery logistics (e.g., for the rapid treatment of new-onset cerebral ischemia, for the negotiation of multiple points of care for the patient requiring neurologic imaging), and brain well being as a focus within overall patient resuscitation. Marketing should also include Dr. George Mashour’s vision of “three pillars” of perioperative neuroscience: 1) clinical neuroanesthesiology, 2) neuroscience foundations of anesthesiology and 3) perioperative management and outcomes in patients with neurologic diseases having non-neurologic surgery. Changing and widening our marketing platform may spark an interest among those who may not have even considered neuroanesthesiology.
 
Finally, I think that we need to assure possible fellows that they will receive adequate training during their fellowship. I think that SNACC can provide a service by offering guidance to fellowships in the United States and all around the world. This can include revising the prior curricular guidelines to allow for a more complete platform, a broader scope (i.e., include Dr. Mashour’s “three pillars”), and yet, a flexible fellowship curriculum. SNACC should take an active role in assuring that fellowship training will follow a prescribed, mature, credible plan for each candidate. This may include playing a role in fellowship accreditation. Further, SNACC should provide educational resources for neuroanesthesiology fellows such as Dr. Deepak Sharma’s idea of a “Neuroanesthesiology Fellow Masterclass” that can consist of online lectures and an in-person workshop to review key concepts and provide a hands-on marketable skill sets.

What are some tasks for SNACC in the coming year?
First and foremost, SNACC needs to continue supporting the future generation. This will include continuing progress toward establishing structure among U.S. and international neuroanesthesia fellowship training programs, updating curricular guidelines, supporting Dr. Andrew Kofke’s progress toward a fellowship accreditation program, and trying to increase the visibility of neuroanesthesiology and perioperative neuroscience as a career path among trainees. SNACC must also be innovative in identifying opportunities to broaden the reach of perioperative neuroscience to include, not just neuroanesthesia and neurocritical care, but also include neural mechanism of anesthetics and the impact of neurologic diseases in the perioperative period.

An additional and very important component of supporting the future generations includes facilitating research. SNACC has recently started the William L. Young Neuroscience Research Award in an effort to carry forth the mission of SNACC to advance the art and science of perioperative neuroscience. An important task will be to not only perpetuate, but to also identify innovative ways to increase financing for this fund. Contributions to the William L. Young Neuroscience Research Award represent an easy and influential way for anyone to play an important role in supporting the future of our specialty.

We need to also assure global inclusion and support for not just the SNACC membership but for anesthesiologists everywhere. SNACC has been instrumental in providing education and support for all anesthesiologists by way of educational content on the website, during the Annual Meeting and at other medical meetings and by supplying clinical guidelines and consensus statements. We need to continue serving in this role. However, we often hear anesthesiologists and intensivists outside of the U.S. refer to SNACC as a “U.S. society.” SNACC is truly a global society that should support the global needs of physicians and scientists everywhere.