The spectrum of issues arrayed before us as anesthesiologists practicing in California is broad and deep, both unique to our state, and also as local iterations of a national agenda. Certainly all members have heard of them before, but some folks have paid more attention than others. Below is my list of 29 important topics on the table for national, state or internal CSA action. This list will be updated on an ongoing basis. I strongly encourage every CSA member to comment and even propose additions to the list.

1. The nurse anesthetist opt-out
2. PPACA
3. Performance measurement
4. ACOs
5. Advocacy
6. Educational Mission - new and improved meetings and new CA meeting, workshops, web-based content, modules, newer modalities
7. Single payer system in CA
8. MICRA
9. Federation of state medical boards and MOCA vs. MOSL
10. AMRs and EMRs
11. Bankrupt state treasury with public programs in the cross hairs
12. Unsustainable increases in health insurance premiums
13. Balance billing proscriptions
14. SGR, 33% problem
15. Potential for new collective bargaining entities, return to guilds
16. AMA vs. coalition of national specialty societies, one big tent and/or reach across specialties, hospital-based, surgical, specialists, etc.
17. Sedation protocols and training
18. CMS IGs - single service, specified notes and timing
19. Drug shortages
20. Surveys by state and feds, drug labeling
21. Changing areas of education and practice
22. Diversion
23. Workers Comp rates
24. Poaching by other medical specialties
25. Transparency and Truth in Advertising
26. AAs
27. Reorganization in CSA (Communications Manager, high level staff roles, website, communication to members)
28. CSA Model Guidelines
29. Insurance abuses, balance billing, underpayments and delays