“The Refill” is a Q&A column designed to provide Clinical Pain Advisor’s readership with various opinions, beliefs and suggestions on managing a pain management practice.

Today’s expert: Edward R. Mariano, MD, MAS. Besides being board-certified in anesthesiology and pediatric anesthesiology, Dr. Mariano is also an associate professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. He is also the co-director of the Stanford Regional Anesthesiology and Acute Pain Medicine Fellowship Program.

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He currently serves as chief of the Anesthesiology and Perioperative Care Service, and associate chief of staff for Inpatient Surgical Services at the Veterans Affairs Palo Alto Health Care System.

Clinical Pain Advisor: What is the biggest challenge to your practice?

Dr. Edward R. Mariano: Our biggest challenge (and also opportunity) is to demonstrate our value as anesthesiologists and pain medicine specialists in the evolving healthcare landscape. Going forward, physician anesthesiologists need to take on leadership roles in coordinating patient care, including by not limited to pain medicine, by collaborating with primary care, surgery, nursing, physical therapy, pharmacy, social work, and other hospital-based services.

One way we can do this is by adopting the Perioperative Surgical Home (PSH) model of care supported by the American Society of Anesthesiologists. Embarking on this journey has been difficult for many departments around the country because of the shortage of practical examples. Because our group at the VA Palo Alto has been exploring a perioperative medicine model since the fall of 2010, we are in a strong position to attempt dissemination and implementation of this model throughout the VA healthcare system.