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In this episode, anesthesiologist Matthew Sherrer and health care consultant Martin Nowak join us to explore the evolving landscape of anesthesia care in the era of AI and automation. We’ll discuss the rise and fall of the Sedasys platform, the current advancements in AI-driven technologies like Edwards Life Science’s Hypotension Prediction Index, and the future of the anesthesia workforce. Can technology ever replace the human touch in the operating room? What are the early warning signs of a shift towards automation, and how can anesthesia professionals adapt strategically?

Matthew Sherrer is an anesthesiologist. Martin Nowak is a health care consultant.

They discussed the KevinMD article, “How AI is reshaping the anesthesia workforce.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Matthew Sherrer and Martin Nowak. Matthew is an anesthesiologist, Martin is a health care consultant, and together they wrote the KevinMD article “How AI is reshaping the anesthesia workforce.” Matthew and Martin, welcome to the show.

Matthew Sherrer: Thank you so much for having us.

Martin Nowak: Thank you.

Kevin Pho: So I’m going to ask both of you just to briefly introduce yourself and just share a bit about your story, background. Matthew, why don’t you go first?

Matthew Sherrer: Yeah, so I’m an anesthesiologist at UAB here in Birmingham, Alabama, in my hometown. Spent 11 years in private practice here before coming over to the academic world, and have been here at UAB for five plus years, and really, really enjoying the academic side of things. Met Martin, gosh, probably a decade ago, just a well-known health care consultant and executive here in town, and we’ve been friends ever since.

Kevin Pho: All right, Martin, a few words about yourself.

Martin Nowak: Good. So I started my health care career as a freshman in college in a Texas psychiatric facility, one of the state hospitals, and soon became, in Birmingham, soon became a surgical tech, an ER tech, drove an ambulance, and stayed in the business, if you will, but went to graduate school in hospital administration, and have run, been the CEO of a rural hospital up to an academic center hospital, and vice president of those in between.

Matt and I share a lot of interest together, including entrepreneurial endeavors, and of course there are lots of changes in the anesthesiology world, so he and I are on top of that, we believe, we think.

Kevin Pho: All right, so we’re going to talk about some of those changes in your KevinMD article “How AI is reshaping the anesthesia workforce.” So Matthew, just tell us the events that led you to write this article with Martin, and then for those who didn’t get a chance to read it, just tell us about the article itself.

Matthew Sherrer: Yeah, so Martin and I have a fun relationship. We banter back and forth, kind of the doctor versus the suit. We talk via text or email pretty much every day, and he’s constantly sending me articles. He’s great at actually keeping up with the business landscape and health care, sending me stuff from various publications, yours included frequently, and we just kind of stay on top of what’s happening out there.

This article in particular was a summation of some events that have happened. These are things that he and I keep up with, but I don’t think that most rank and file anesthesia clinicians on the front line necessarily pay attention to, and we thought, hey, this is good stuff for people to be paying attention to, let’s write something and bring it to the forefront just so people can see what’s happening out there.

And what we’re talking about in this article in particular is kind of the evolution of anesthesia delivery and how AI is influencing that. We now have platforms that are predictive and prescriptive, meaning they don’t just monitor patients in the OR anymore, they actually predict events before they happen and they tell you what to do. They’re prescriptive, right?

And then a few months ago there was a big transaction where a large entity bought a technology that was prescriptive and predictive. That company also happens to own an infusion pump platform, and if you put all those things together, to me what that says is that in the near future we’re going to have those prescriptive and predictive analytics in line in a closed loop system with the infusion pumps that can deliver that.

Now what does that mean for us as anesthesia providers? You go tell people this, and you talk about, you know, that this is happening for hemodynamics, this is happening now with ventilators that have end-tidal adjustment, they can actually regulate the delivery of anesthesia gas. If we were to develop something for muscular relaxation, neuromuscular blockers and reversal, man, you’ve put together a pretty autonomous anesthesia machine. What does that mean for us?

And I love to ask that question in the OR, and I actually love to see the varied responses, because some people say, oh my goodness, why are they going to need me, and others say, hey, this is really cool, this is going to allow me to free up my hands and use my brain and make better decisions. So just an interesting, interesting topic, I think. Martin, did I say that right at all?

Martin Nowak: Yeah, absolutely. What resonated with me when Matt and I began talking about this is it reminded me of, as Matt often does, decades ago when I wrote my thesis, and I wrote my thesis on ordering laboratory tests, the right tests for a given diagnosis.

The reason for that was, at that time it certainly was not AI, but it was the technology of machines that were going to do multiple tests on a single sample, and the pathologists were very concerned about what that was going to do to their jobs, their income, were they even going to be needed. Not much different than AI today and the anesthesiologist. I mean, I’m old enough that when I worked in the lab we used the little clickers to count cells, and then the technology changed all that. It’s just remarkable. So it resonated with me, because it’s not much different than what happened to the pathologists many years ago.

Kevin Pho: So Matthew, give us an example. Take us into the OR. What would be an example of AI that could make a predictive and a prescriptive solution? What would be a common example you would see?

Matthew Sherrer: Yeah, so the big one in our field right now is the Hypotension Prediction Index. It’s Edwards, is the company that started it. I have no affiliation with them, it’s their platform. We actually use it here in one of our UAB hospitals. It is remarkable. It is a small little finger cuff that inflates to just above mean arterial pressure. It gives you an arterial line waveform tracing, which is pretty accurate, and then off of that waveform, the AI can give you this little thing called, they call it HPI, Hypotension Prediction Index, that literally sees around corners. It can tell you when something’s going to happen. We’ve been using it for a few months here and have had great success with it. So that’s one.

The other, GE now has a vaporizer that you can essentially choose an end-tidal gas concentration, you can set it, and the vaporizer actually regulates itself. So it’s just things that are normally our hands, right? I’m giving IV fluid, I’m adjusting infusions, I’m turning the vaporizer. Our anesthetists are in the operating room, they’re doing that with their hands. It’s something that we do with our hands, and now the machines are doing it. And again, it makes people feel different ways. Some feel very uncomfortable with it, some embrace it wholly, and it’s really just incredibly interesting to watch the varied responses.

Kevin Pho: And what do you think, Matthew, how does it practically change your role in the OR when you have more and more of these things that you used to do now done by a machine?

Matthew Sherrer: I personally know my mindset is different than others, and I love this kind of stuff. I think it’s incredible. I think it does allow us to take better care of patients, and what you’re talking about here is change management, and we know that you will see varied responses to change.

I think it’s exciting. I think it allows us to take better care of patients. I see kind of the quote that Martin put in that article about change being a constant. It’s going to happen. I embrace it. I think it’s going to allow us to take better care of patients. I think it actually will allow us to scale in a way that we have never been able to do before. We have drastic workforce shortages, and I think this is a potential scale opportunity to bring our skills, our knowledge, to more patients. So I see it as a wonderful thing, but maybe one of a few.

Kevin Pho: So Martin, take us into the mind of a hospital executive. Tell us the factors that go into the decision when implementing some of these AI related tools, specifically as it relates to anesthesiology. What are some of the factors that the hospital team has to consider before implementing something like this?

Martin Nowak: Sure. Of course there’s the cost of the startup. Second is, how accurate is it, is it going to retain the accuracy, or is it like vaporware? You know, we just don’t know that.

I think the third one is, the reason I share Matt’s lack of great concern in terms of anesthesiologists is we still need to have who will guard the guardians, and we still need the brain power of the trained human to oversee all this.

And then next, I’m also concerned about how we might distribute these AI advantages to smaller hospitals, to the general public who can benefit from this. Certainly the larger hospitals will, but we need to benefit society and the public as well. So we have distribution, we have cost, and then we also have oversight, and we will continue to need anesthesiologists in the oversight role.

Kevin Pho: And Martin, do some anesthesiologists have things to worry about as technology takes up more of their responsibilities? Does that ever factor into decision-making, maybe in the back of a hospital executive’s mind, maybe we can save some money from a workforce standpoint? Does that ever factor into the decision-making?

Martin Nowak: I would have to say of course. In specific to anesthesiology, we already have somewhat of a bind of the anesthesiologist and the CRNAs and who does what, in states that allow more and less and so forth. So the question is, will AI replace some or all, as some fear? I don’t believe that, but some of the duties, that may be the case.

But there’s still ample opportunities to take care of the patients in the OR, after the patient is out of the OR, and anesthesiologists can fill many of those that I believe are still gaps today in the patient care continuum.

Kevin Pho: Matthew, so I’m hearing, you know, correct me if I’m wrong, that there may be a spectrum of responses when it comes to these AI tools. You’re certainly a proponent of it, and I’m getting the sense that not everyone may agree with you, right? So tell me about some of their concerns and their perhaps hesitance in embracing some of these AI technologies. Give us a sample of some of their pushback.

Matthew Sherrer: Yeah, so I mean it comes down to the question that when I bring this up, point this out, show people this article, the first thing they say is, well, what am I needed for? And that’s for anesthesiologists and a nurse anesthetist, right? So it’s not just one or the other. People have that first visceral response of, well, what happens if I’m not needed, how am I going to pay my bills, how do I, I got kids to raise, I got mouths to feed.

So I think that’s the first response, and I try to tell people, hey look, when you go get on an airplane there’s a whole lot of technology in that cockpit. That plane can do a whole lot of stuff by itself. However, if you don’t see the pilot sitting in the front seat, co-pilot sitting in the front seat, you’re probably turning around and getting off, right? I’m not going to be one of the first guys to get in a self-driving car. I’ll give it a few years and see how it goes. But that kind of stuff takes a long time.

We have a lot of skills, a lot of knowledge that are still needed, and by the way, there’s so much work to do these days that we can’t even begin to do it all. We have drastic shortages of anesthesiologists and nurse anesthetists. So I try not to stoke fear, and I kind of wrote this article in that way with Martin to say, look, we’re not fear-mongering, we’re actually trying to see around corners as well, in this kind of Rita McGrath discovery-driven planning way of keep your eyes up, see what’s happening, look far down the road, and realize that these things are still down the road. There’s still a long way to go. You’re going to feed your family.

But let’s keep these things in mind and let’s be smart, because if we see these things coming it doesn’t take much to navigate into new and fun things, whereas if we wait and let it get upon us, well, that’s a drastic change that has to happen. So keep your eyes up and keep looking down the road.

Kevin Pho: So Matthew, on this podcast, on KevinMD, we talk about these AI tools a lot in pretty much every area of medicine. It’s disrupting a lot of areas of medicine, and one of the sayings that often comes up is that physicians or clinicians who embrace AI may replace those that don’t. So rather than worry about the AI itself replacing doctors, the doctors who embrace AI may replace those that don’t. So how can that saying relate to some of your anesthesia colleagues who may take more of a resistance approach to AI? How can they embrace some of this technology knowing in the back of their mind it may replace some of the things or disrupt what they normally do?

Matthew Sherrer: Yeah, so I guess it depends on how you look at the field of anesthesiology. If you look at the field of anesthesiology being what happens in the operating room, this is a big threat. If you look at anesthesiology as being caring for patients throughout the entire surgical journey, there’s a lot more opportunities out there.

Dan Sessler, kind of a titan in our field, wrote an article recently called “The gathering storm,” and he talked about an entire new specialty, right, an entire new rail for our specialty in postoperative medicine. These wearables are getting really smart. These wearables now will actually tell you if you have apneic episodes, apparently, I read that the other day.

So to me, let’s embrace post-operative care, right? We’re working hard on the pre-operative optimization. The intraoperative part of things team anesthesia has collectively made incredibly safe. So what’s next? And to me, I agree with Dan Sessler fully, postoperative medicine is a huge opportunity. Wearables, technology, AI will allow us to expand our scope to far greater areas than just the intraoperative period. So I think that post-operative period is an incredible, incredible future opportunity.

Kevin Pho: Martin, what do you think? Do some anesthesiologists who may not adapt to this new technology, and perhaps refocus some of their education, training, to what Matthew says, like postoperative care, people who don’t change, do they have something to worry about?

Martin Nowak: I would have to say yes. One must adapt to the changing environment. I’m always a bit surprised by some of this fear when technology changes, which I’ve seen my whole life, in that every intervention, AI, whatever it is, actually creates new opportunities, and one must grab those opportunities.

I think Matt is absolutely correct, the opportunities for anesthesiologists in the whole continuum, and I’ll repeat what he said, especially, can be such an opportunity for anesthesiologists. There are also new jobs coming around, right, for physicians, chief AI, chief of IT, chief of, in all these realms, great opportunities for anesthesiologists to participate.

Kevin Pho: And Matthew, are you seeing, not only in your hospital, are you seeing hospitals across the country when you talk to your national colleagues, seeing it the same way? Are they providing kind of these postoperative anesthesia opportunities?

Matthew Sherrer: You know, I think everybody is so focused on, you know, head down doing the work in front of them. There’s so much work that I think, for a lot of people it’s come to work, do a great job, go home, try to get some rest, be a good parent, be a good spouse, and come back and do it again.

So are people seeing some of those opportunities? I generally find that I surprise people when I talk about this kind of thing, and really, in truth, that’s why Martin and I did this, is just to bring these kinds of things to the forefront, just to say, hey, something to pay attention to. But I don’t get the sense that the large majority of anesthesiologists, nurse anesthetists, are paying attention to this as much as perhaps we are.

However, at the higher level, I will certainly say that your department chair, as my chairman certainly is, is keyed into AI. We actually have our own data scientists now and kind of an entire division devoted to AI. I know that the large anesthesia groups do as well. But your day-to-day, you know, people in the operating room, I don’t know, I don’t know if they’re paying attention to this that much.

Kevin Pho: Martin, from your perspective as a health care executive, what kind of advice do you have for anesthesiologists if they want to, I guess, quote unquote, future-proof their profession going forward with these new technologies? What’s your perspective?

Martin Nowak: Yeah, I think this goes to piggyback on Matt’s comment. They’re working hard now, the anesthesiologists, CRNAs, you know, they have families and jobs and so forth, yet they must read every day what’s going on. This AI stuff and technology is moving so fast that if they don’t keep up with it and understand how to adapt to it, I think they can get lost.

So I would urge anesthesiologists to read a lot, talk about this in, you know, among their social group, their physician social group, and participate. If you don’t get active in it, you certainly will be left behind. I do believe that.

Kevin Pho: We’re talking to Matthew Sherrer and Martin Nowak. Matthew is an anesthesiologist, Martin is a health care consultant. We’re talking about the KevinMD article “How AI is reshaping the anesthesia workforce.” Now I’m going to ask each of you just to share some take-home messages to my clinician audience. Martin, why don’t you go first?

Martin Nowak: Sure. I think the take-home message I would give maybe is best stated by Darwin, who said the most powerful natural species are those that adapt to environmental change but without losing their fundamental identity, which gives them their competitive advantage. So anesthesiologists can remain anesthesiologists. They actually can grow in strength and demand and influence.

Kevin Pho: And Matthew, we’ll end with you.

Matthew Sherrer: Yeah, so I would go with kind of how we ended the article, which is that Rita McGrath discovery-driven planning mindset of, as Martin said, reading, reading KevinMD, but also reading books. We based that paper that I had done in the past called “The Icarus Paradox” actually off of a book called The Icarus Paradox, but mainly off of a book by Rita McGrath called Seeing Around Corners, this idea of discovery-driven planning, meaning that if you’re driving a car and you see a wreck way, way down the road, you’ve only got to minimally adjust your steering wheel, right? See things coming, and it takes minor adjustments to navigate safely, whereas if you wait to make an adjustment until you’re right up on that wreck, you might be a part of it too. So keep your eyes up.

Plenty of great information resources out there, KevinMD being one of them, lots of great books out there. But I’ll kind of close with what Andy Grove said, which is that nobody owes you a career, right? It’s actually up to you to decide, make the decisions for your career, your timing, that all falls to you as the sole proprietor of, for me, Sherrer Incorporated, right? It’s up to me to make those decisions, and I’ve got to keep my eyes up to be able to make wise decisions.

Kevin Pho: Matthew, Martin, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Matthew Sherrer: Thank you.

Martin Nowak: Thank you so much.