President’s Messageby Dolores B. Njoku, MD
Dear Colleagues, Volatility, uncertainty, complexity, ambiguity (VUCA) have become household terms in academic medicine. What is clear in my opinion is that every institution has experienced VUCA. Additionally, no medical specialty has been spared from the effects of VUCA. This is not a comprehensive essay on VUCA since I am limited by word count, as well as expertise, since I am neither an economist nor an Army general, depending upon who you think coined VUCA first. I can only address what I know, as I serve as president of AUA, and as a life-long academic learner, I can provide additional resources to help you on your journey. A brief primer on VUCA and how it can affect academic anesthesiology. What is VUCA? In the most basic sense, this term describes types of challenges that affect any organization and categorizes them to facilitate the types of responses that may mitigate these challenges. However, volatility in anesthesiology can mean many things. Volatility in anesthesiology can be equated with variability in patient responses to the care that we provide, variability in the cost of providing care that is governed by re-imbursement changes as well as volatility in patient volume and anesthesiology workforce. Similarly, uncertainty can be equated with determinants of volatility since, in my mind, they are forever connected. As examples, uncertainty in patient responses can be driven by external factors such as dosing practices or the environment, as well as internal factors such as genetics, protein expression, immune responses or a combination of the three. Uncertainty in cost of care can be driven by patient morbidity, anesthetic or surgical type, technology, and re-imbursement. Uncertainty in patient volume may be driven by provider practices, insurance, as well as hospital capacity. Uncertainty in anesthesiology workforce may be driven by medical students going into the specialty, specialist retiring or changing job focus, as well as hospital capacity to flex up or down depending on patient volume. Complexity in anesthesiology can also be determined by many things, such as patient morbidity, technology, work-force identity, as well as pathophysiology of the patient or environmental responses that provide volatility to the environment in which we work. Ambiguity in anesthesiology is far more multifaceted. Ambiguity incorporates inherent variability, uncertainty, and complexities associated with interpretation of patient and research data, as well as communication between patients, anesthesiology colleagues and other stakeholders in the perioperative environment. For most academic areas, we would stop here. However, we are academic anesthesiologists, VUCA only helps identify challenges–once identified, we work together and find solutions. It is no mistake that VUCA in Anesthesiology as I described, is familiar. This critical aspect of VUCA makes it a known adversary, a term commonly studied in the cybersecurity industry where the focus is to protect people and systems utilizing policies, processes, and technologies. Hence, it is not surprising that in many ways, anesthesiologists are the cybersecurity agents for patients. Moreover, a known adversary allows us as members of the AUA to provide proactive, instead of reactive approaches. Our back to university approach was determined to be the best way to ensure a strong base for the future headwinds that we speculated were on the horizon. Although we could never completely predict what would happen next, work force challenges were looming and needed acknowledgement. Our first back to university meeting in 2024 possessed all of the euphoria of any new prospect. Our second meeting in March 2025 was preceded by a travel restriction and a change in management companies. Even so, academic diehards like me met, discussed and exchanged ideas. Guided by our strategic plan and our revised mission to promote excellence in academic anesthesiology and professional growth throughout the careers of educators, academic leaders, and researchers, we provided a program that was meant to start a year-long (or yearly-long) conversation. The AUA would provide the venue for strategic conversations regarding improved collaboration, communication, detection and prevention of threats to our patients, as well as resource allocation for our patients. In seven months, our annual meeting will be in Seattle, Washington, March 26 – 29, 2026! This year, we will be hosted by University of Washington Medicine and held at the University of Washington Husky Union Building (HUB) in Seattle, Washington. Our accommodations will be at Graduate by Hilton Seattle (pun intended). This year’s meeting is really shaping up to be something special. The abstract submission site is open and ready. Dr. Deepak Sharma has ensured an engaging and exciting host program. The AUA board chairs have promised innovative and engaging sessions. Reach out to me directly if you are interested in additional opportunities to participate. I look forward to your continued participation. Respectfully submitted, Author
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