Interview with a Leader in the Field

Interview with a Leader in Field: Joseph Neal, MD

Jul 17, 2018, 13:30 PM by Kristopher Schroeder, MD
Dr. Joseph Neal

What has ASRA meant to you? For me, it has meant phenomenal academic opportunities, world-class educational programs, and an external group of colleagues and mentors that I can rely on should I have an academic or clinical question for which I cannot find the answer locally. I recently had the opportunity to sit down and discuss the role that ASRA has had in the academic and clinical career of Dr. Joseph Neal. Dr. Neal is a past president of ASRA and the past editor-in-chief of Regional Anesthesia and Pain Medicine (RAPM). While our conversation was wide-ranging, what struck me and what I hope to convey to you was the passion that Dr. Neal has for this organization. What was also evident is that Dr. Neal has helped to create an organization committed to the development and advancement of ASRA members at all stages of their career.

K. Schroeder: What changes have you seen in the ASRA meetings throughout the years?

J. Neal: Those early meetings were smaller and focused more on workshop-based teaching. More recently, the meetings have become increasingly evidence based. Instead of focusing on the technical aspects of blocks, we now appropriately discuss why we do things, why we shouldn’t do things, what the expected outcome is, and potential complications. Practice management and advocacy have increased their presence, thanks largely to the leadership of Drs. De Leon, Buvanendran, and Provenzano. Perhaps the most significant change was splitting into the fall chronic pain and the spring regional anesthesia/acute pain medicine meetings. This was a natural evolution as the subspecialties matured.

K. Schroeder: What does being an ASRA member mean to you and what have you gotten out of being a part of the organization?

J. Neal: Outside of my own department, ASRA and the American Board of Anesthesiology are the most significant organizational involvements of my career. ASRA was a vehicle to become academically involved in the subspecialty. That involvement allowed me to collaborate on projects with many friends and colleagues, some of whom I have grown older with and some of whom have transitioned from a mentor/mentee relationship to valued colleague. It has been great fun to watch these colleagues’ career development, both within and outside of ASRA.

ASRA meetings have become a succession of fun memories and annual opportunities for comradery with folks whom I grew up with professionally.

K. Schroeder: Who were your mentors, and what qualities did they have that made them, and by extension you, successful?

J. Neal: Dave Brown mentored my editorial career, and my ascension to editor-in-chief was largely with his support. Other people who made a big difference to me early on in ASRA were Jim Eisenach and Denise Wedel. While not exactly mentors, the support of Vincent Chan, John Rowlingson, Rick Rosenquist, and Jim Rathmell was crucial to my sanity during my leadership years.

 Excellent mentors are open to new ideas and new faces—they recognize and foster potential talent. Good mentors—and I hope I have at least some of these qualities—realize how important the next generation is to the future of the specialty and unselfishly help to train those people. Just as importantly, good mentors know when it’s time to step aside and let the mentee take on more responsibility.

K. Schroeder: How has the mentorship process evolved within ASRA?

J. Neal: Evolving is the right descriptor. ASRA has always been a very welcoming community. People meet each other, bounce ideas off each other, and then collaborate on projects together— sometimes as mentor, sometimes as colleague. Recently, under Drs. De Leon and Sites’ leadership, ASRA has begun to formalize these mentor/mentee relationships and faculty development, which is a wonderful thing. The ability to find a mentor within ASRA has always been there for those willing to seek out the opportunity, but now the Society is taking steps to make doing so even easier.

Over the past 5 years, ASRA has also formalized the opportunity for members to self-nominate for committees and associate faculty. The goal is to facilitate young faculty members who don’t yet have an academic track record getting their foot in the door by letting their interest be known. If you look at the numbers, the associate faculty program has been almost too successful— we have had more people volunteer than we have room for.

K. Schroeder: What advice would you give a resident, fellow, or junior faculty member who is just starting to get involved with ASRA?

J. Neal: Vincent Chan and I reminisce about the 1986 ASRA meeting where we first met at a poster session—which turned into many years of friendship and collaboration. I met Terre Horlocker, Admir Hadzic, Jerry Vlodka, and many others the same way. Those “chance meetings” developed into friendships both personal and professional.

If you’re new to ASRA, take advantage of what the society has to offer. I believe you will find your integration into the society realized over a series of small steps directly linked to your involvement. If you really want to become involved, volunteer to be on the committees, come to the meetings, present your abstracts. As you start to know people and develop relationships and as your career starts to grow, so will your opportunities in ASRA. Most folks who get involved find ASRA an incredibly welcoming society.

K. Schroeder: As you look back, has there been a defining moment in your academic career?

J. Neal: More a collage than a single accomplishment. Working on the upper extremity review article and various practice advisories, being appointed editor-in-chief of RAPM, and various leadership roles within ASRA have all been wonderful and fulfilling opportunities.

K. Schroeder: What questions do you think investigators should be focusing on now?

J. Neal: On the acute/regional side, my opinion is the big scientific questions revolve around improving patients’ functional outcomes and being willing to do so in ways that don’t always involve placing blocks. Part of this includes further investigation into long-acting analgesic modalities, system improvements, and longer-term follow-up. I find these questions much more relevant than “I just described the seventh approach to the sciatic nerve.”

On the pain medicine side, work still needs to be done to determine if and under what circumstances various interventional procedures are indicated. In my humble opinion, ASRA can influence these questions by continuing to fund meaningful research without being overly judgmental into the “worthiness” of the scientific question being proposed. Let’s be honest with ourselves: 25 years ago, who would have ever thought that lipid would have anything to do with mitochondrial metabolism, much less be an effective antidote for one of our deadliest complications? Not every funded project will hit a home run, but let’s be careful not to overthink what we believe will produce meaningful return on investment. As my good friend Chris Bernards was fond of saying, “Never believe everything you think.”

K. Schroeder: What is the secret to your academic longevity? How have you avoided burnout?

J. Neal: If there is a secret, I argue that it’s counterintuitive. That is, nirvana is not about preserving income, getting relieved as early as possible, or complaining about the madness of operating room attire policies. Finding balance in one’s life is always difficult, but when it comes to the work portion of that equation, those who seem happiest are those who continue to enjoy direct patient care mixed with some other form of professional involvement, be it research, teaching, or administrative duties. Those with the most professional satisfaction seem to derive great pleasure from taking good care of the people they exist for—their patients or trainees at work and their family at home. There is interest and motivation to stay involved in something beyond just themselves and simple pleasure in their day-to-day routine that seems to energize those who are happiest in our profession. My observation is that you are more likely to remain stimulated and interested in the career portion of your life if you focus on taking care of your patients and your profession.

K. Schroeder: What is on the horizon for you academically?

J. Neal: As my clinical career comes to an end over the next few years, there are various academic projects that I hope to complete. One involves using different methodologies to look at those extremely rare neurologic complications associated with regional anesthesia. It’s a topic that I am interested in, and it provides a great collaborative opportunity with friends from around the country.

K. Schroeder: Is there anything else you would like the readers of the ASRA News to hear from you?

J. Neal: I have very much enjoyed the relationships that I have developed within ASRA over the years. ASRA, its members, and professional staff have given me so much more than I have ever given in return.

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