Shared Perspectives: Origins of ASA and the American Board of Anesthesiology

ASA and the American Board of Anesthesiology (ABA) are separate organizations with separate missions. Together, their work is important to the practice of anesthesia and the profession of anesthesiology. This edition of Shared Perspectives will look at the origins and early decades of ASA and ABA as they began to develop into the organizations they are today. The birth of organized anesthesia in the U.S. October 6, 1905, was a fair day in Brooklyn, New York, with afternoon temperatures in the 60s. A group of eight physicians and one medical student met at the Long Island College Hospital (LICH) at the invitation of Adolph Frederich “Fred” Erdmann, MD. Erdmann was an 1897 medical school graduate and had served as anesthetist of the LICH since 1900. At 37 years of age, Dr. Erdman was the oldest of the nine gathered on that day – all of whom shared a common interest in anesthesia. This gathering became the founding meeting of the Long Island Society of Anesthetists (LISA) – and the origin of the American Society of Anesthesiologists. The Long Island Medical Journal announced the formation of the LISA in its February 1907 issue, which also included eight articles on various aspects of anesthesia. By 1911, the original nine members had grown to 23, including three physicians practicing in New York City. The LISA was renamed the New York Society of Anesthetists (NYSA), and its headquarters moved to Manhattan. (This NYSA was different from the current New York State Society of Anesthesiologists, or NYSSA, which was chartered as a component society of the ASA in 1948.) Soon, there was discussion of creating a national society of anesthetists in collaboration with the American Medical Association (AMA). In 1912, the AMA blocked an initial attempt at creating a new AMA Section on Anesthesia, which would signify the recognition of “anesthesia” as a medical specialty. But in the same year, the indomitable Francis McMechan, MD, led the formation of a new national society – the American Association of Anesthetists (AAA). The AAUSC, IARS, and the McMechan societies World War I catalyzed the advancement of anesthetic care and resuscitation, and AAA membership grew. In a flurry of activity, Dr. McMechan organized numerous regional societies under the AAA's umbrella. In 1926, the AAA became the Associated Anesthetists of the United States and Canada (AAUSC). Dr. McMechan was as committed to the scientific progress of physician anesthesia as he was to its political organization. In 1919, he helped form the National Anesthesia Research Society (NARS), which focused on developing basic science and clinical research in anesthesiology. As NARS membership grew, it became the International Anesthesia Research Society (IARS) in 1925. Throughout the 1920s and 1930s, IARS, AAUSC, and its associated regional societies jointly held a large annual meeting called the Congress of Anesthetists. The NYSA/ASA: A separate stream in organized anesthesia In the meantime, the NYSA also continued to hold regular business and scientific/clinical meetings. Anesthetists from outside the New York area were invited to present papers and discuss relevant topics, and NYSA membership also expanded to include physicians from other states. The NYSA celebrated its Silver (25th) Anniversary in 1930. On that occasion, Paul Wood, MD, was elected as secretary-treasurer, and attendees began to discuss the possibility of a national organization to certify physicians who practiced anesthesia. By 1936, the NYSA included members from 17 different states, a much wider representation than might be inferred from its name. As the Great Depression precipitated economic instability, discussions on certification accelerated. Over time, a rift had grown between leaders of the NYSA and the McMechan organizations over two competing avenues for certification. Dr. McMechan, who had lost faith in the AMA early on, created his own certifying body called the International College of Anesthetists in 1933 (not to be confused with the American College of Anesthesiologists) for physicians, dentists, and scientists involved with anesthesia practice or research. However, the criteria were weak and inconsistently enforced. Within a few years, the number of applicants declined. On the other hand, the NYSA still believed in the importance of support from the AMA – a physician-only organization – in conferring broader legitimacy to the young specialty. The NYSA excluded nonphysicians from its new “Fellows in Anesthesiology” certification. Even so, physicians from 23 states applied for NYSA Fellow certification by the end of 1935. The NYSA membership base expanded so rapidly and widely that in February 1936, Secretary-Treasurer Paul Wood, MD, initiated the renaming of the NYSA to the American Society of Anesthetists (ASA). The ASA was now a national organization of physicians practicing anesthesia. On April 8, 1937, the organization awarded Adolph Frederich Erdmann, MD, the original founder of the LISA, with a silver replica certificate recognizing him as Member #1 of the American Society of Anesthetists (Figure 1).Figure 1: Erdmann Certificate, Adolph Frederick Erdmann Collection. Wood Library-Museum of Anesthesiology. Retrieved from woodlibrarymuseum.org/museum/erdmann-certificate/.After Dr. McMechan died in 1939, all of his anesthesia organizations folded into the IARS, which retained its scientific and international character, and ASA rapidly became the ascendant professional organization for physician anesthetists in the United States. Origins of the ABA The ASA leadership quickly recognized the importance of certification on a national scale through collaboration with the AMA – on a level on par with other medical specialties in the U.S. To that end, ASA engaged with both the AMA Guiding Committee and the Advisory Board for Medical Specialties and also gained support from the AMA Section on Surgery. The American Society of Regional Anesthesia (unrelated to the current organization of the same name) served as a second national anesthesia organization to offer support for certification. “Both the ASA and the ABA continue to be important organizations for the advancement of the medical specialty of anesthesiology and the recognition of individuals' achievements and qualifications. While separate entities with separate missions, the work of one complements that of the other.” In February 1938, the Advisory Board for Medical Specialties of the AMA Council on Medical Education and Hospitals approved the American Board of Anesthesiology (ABA) as an affiliate of the American Board of Surgery. The ABA took over primary certifying responsibility from the ASA. The new ABA was announced in the May 21, 1938, issue of the Journal of the American Medical Association with its founding members: Thomas Drysdale Buchanan, New York, New York, President Henry S. Ruth, Philadelphia, Pennsylvania, Vice-President Paul M. Wood, New York, New York, Secretary-Treasurer John S. Lundy, Rochester, Minnesota Emery A. Rovenstine, New York, New York Harry Boyd Steward, Tulsa, Oklahoma Ralph M. Tovell, Hartford, Connecticut Ralph M. Waters, Madison, Wisconsin Philip D. Woodbridge, Boston, Massachusetts The ABA developed qualification criteria. The Founders' Group was selected from a list of individuals who could provide evidence of being specialists in anesthesia: 1) medical school professors and associate professors, 2) physicians who had limited their practice to anesthesia for at least 15 years, and 3) those who held a Certificate of Fellowship from the NYSA/ASA and who had applied by January 1, 1939. The second of those Founder Certificates went to pioneering anesthesiologist John S. Lundy, MD (Figure 2), of Mayo Clinic. All other candidates who followed the Founders could qualify for ABA certification only by examination.Figure 2: ABA Lundy Certificate, John Silas Lundy Collection Archives. Wood Library-Museum of Anesthesiology.Entrance for the examination required: Graduation from a recognized medical school in the U.S. or Canada Completion of an internship Completion of a three-year period of graduate work devoted to anesthesia in an approved setting Evidence of good moral character and a statement of intent to limit the candidate's medical practice to anesthesia. The original exam had three parts: An essay examination covering broad topics in basic medicine and anesthesia An oral examination of similar topics, including the proper handling of high-pressure gases and flammable agents A practical exam conducted in the applicant's own hospital whenever possible. During its initial years, the ABA worked to define its mission, better clarify its position, and refine its examination process – all while evaluating and certifying applicants. Initiatives were implemented to make the written and oral exams more structured and objective. In time, the practical aspect of the exam was discontinued. The number of anesthesiology residencies and the structure and requirements of their educational programs increased over time to improve the uniformity and consistency of training and clinical skills among the individuals applying for certification. An important step was the recognition of the ABA as fully independent of the American Board of Surgery on February 16, 1941. This change came soon after the fulfillment of a longstanding dream – the unanimous approval of a new AMA Section on Anesthesia in 1940, signifying that anesthesiology was on equal standing with other major medical specialties. World War II also catalyzed growth in the specialty, as many general practitioners who administered anesthesia for the first time during the war committed to a new career in anesthesiology on a full- or part-time basis when they returned home. During the war, there was also intermittent discussion of replacing the term “anesthetists” with “anesthesiologists” to emphasize the scientific underpinnings of the specialty. This change formally occurred April 12, 1945, and the American Society of Anesthetists became the American Society of Anesthesiologists. The American College of Anesthesiology (ACA) was a third certifying body that was active from 1947 until 1986. It offered certification in anesthesiology with less stringent requirements than the ABA. However, as physicians wanting to specialize in anesthesiology by the late 1970s were now expected to have completed an anesthesiology residency, the ABA served the certification needs of all graduating anesthesiologists, and the ACA ceased to offer certification. Both the ASA and the ABA continue to be important organizations for the advancement of the medical specialty of anesthesiology and the recognition of individuals' achievements and qualifications. While separate entities with separate missions, the work of one complements that of the other. Leadership overlap has also continued, with 21 anesthesiologists serving as presidents of both organizations over time. As of 2023, ASA had 57,991 members and 67,806 anesthesiologists have been board certified since the ABA's founding. Acknowledgment: Special thanks to Douglas Bacon, MD, for his review and observations that contributed to this article.William L. McNiece, MD, President, Wood Library-Museum of Anesthesiology, Chair, ASA Abstract Review Subcommittee on History and Education, and Pediatric Anesthesiologist, Indiana School of Medicine, Indianapolis, Indiana.Jane S. Moon, MD, Trustee, Wood Library-Museum of Anesthesiology, Chair-Elect, ASA Abstract Review Subcommittee on History and Education, Associate Editor, Anesthesiology, and Chair, California Society of Anesthesiologists Committee on the History of Anesthesia.

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