In this age of artificial intelligence, the relevance of each medical specialty is shifting and uncertain. From here on, medical specialists will have to weigh the relevance of:
- Training and certification in their own specialties
- Licensing and credentialing to practice and bill as experts in those specialties
- The growing need to learn and practice skills traditionally considered outside their specialties
- Adapting as others learn and practice skills traditionally restricted to their specialties
Interestingly, “today” may be the right time for those whose skills are expanding into other specialties. Those whose own territory is being encroached upon, and is shrinking as a result, may not want to accept and adapt to the changing times, at least “not today.”
Anyhow, specialists trained and certified in the traditional way cannot cover every patient as procedural needs grow exponentially, so other specialists who are immediately available are expected, and may even be required, to expand their skills. It is no longer unusual for emergency and critical care physicians without anesthesiology training, and even emergency medical technicians and other clinicians, to manage airways safely, with or without supraglottic airway devices, and even to perform endotracheal intubation in the era of video laryngoscopy. Likewise, it is no longer unusual for pathologists, perioperative clinicians, and even vascular access technicians without radiology training to use ultrasound for diagnosis and treatment in the era of personal point-of-care devices. Moreover, it may be unclear when anesthesiologists themselves began independently performing and interpreting transesophageal echocardiography around the time of surgery. But the needs of the time must have called for it, to ensure appropriate perioperative management of cardiac pathophysiology, first in patients undergoing cardiac surgery and later in those undergoing noncardiac surgery as well.
Similarly, could now be the time to expand the anesthesiologist’s armamentarium to include esophagoscopy, to evaluate the upper gastrointestinal tract and even keep it uneventful, in the rapidly evolving era of glucagon-like peptide-1 (GLP-1) receptor agonists? Could that expansion rest on the easy availability of disposable fiberoptic bronchoscopes, and on the feasibility of using them off-label for esophagoscopy, potentially transnasally in awake patients before or after surgery, and potentially transorally in anesthetized patients during surgery with advanced airway devices in place? Finally, could it depend not only on anesthesiologists growing at ease with learning to perform esophagoscopy safely, to assess the upper gastrointestinal tract and ensure its adequacy, but also on institutions growing comfortable with off-label esophagoscopy, weighing the billability of such procedures against the liability of patient safety events?
Essentially, it will be interesting to see if, and when, anesthesiologists’ skills expand to off-label transnasal or transoral esophagoscopy with a disposable bronchoscope, overcoming the perception of skill encroachment. That expansion would meet patients’ perioperative needs in an era of rapidly changing diet and disease patterns, in which upper gastrointestinal anatomy, physiology, and pathology may be changing quickly because of bariatric surgery, GLP-1 receptor agonists, and gastroesophageal reflux-related disorders, respectively.
Deepak Gupta, Mohamed Ismaeil, and Amit Jain are anesthesiologists.
