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May 2003
Volume 67 |
Number 5 |
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Innovation and Discovery: The Future of Our Specialty
Although a physician was the first to administer surgical
anesthesia (Crawford W. Long, M.D.), until the 1940s
the practice of anesthesia was considered mostly a technical
skill, and administration was relegated to nurses and
other nonphysicians. Thereafter, facilitated by the
need for physicians to administer anesthesia in World
War II, physicians discovered the challenge in anesthesiology
and began to choose it as a specialty. More importantly,
anesthesiologists began to use their medical knowledge
and skill to improve anesthesia safety by developing
new drugs, techniques and equipment.
As more anesthesiologists became trained, they were
either responsible for or were primary participants
in multiple landmark advances, including development
of innovative gas machines (E. I. McKesson, M.D.), the
circle system (Brian Sword, M.D.), cardiopulmonary resuscitation
(Peter Safar, M.D.), the clinical use of muscle relaxants
(Harold R. Griffith, M.D.), improved maternal and neonatal
care (Virginia Apgar, M.D.), the copper kettle vaporizer
(Lucien Morris, M.D.), the cuffed endotracheal tube
(Arthur E. Guedel, M.D.), formation of critical care
units (Henrik Bendixen, M.D.), formation of pain clinics
(John J. Bonica, M.D.), measurement of anesthetic potency
(Edmond I. Eger II, M.D.), measurement of blood gases
(John W. Severinghaus, M.D.) and development of forced-air
patient warming (Augustine). American anesthesiologists
conducted important research in a wide variety of fields,
ultimately leading to improved safety in perioperative
care.
By the 1980s, anesthesiology was a highly respected
medical discipline. Top-quality U.S. medical students
were filling residency programs, academic anesthesiologists
were being awarded competitive National Institutes of
Health (NIH) grants, training grants were abundant,
and American anesthesiologists authored the large majority
of articles in Anesthesiology and other journals
in our specialty. The number of anesthesiologists being
trained was at the highest level ever. Coincidentally,
nurse anesthesia training programs were being closed.
Now, however, the picture is not so rosy. Academic anesthesiology
is under tremendous pressure and is the victim of “The
Perfect Storm.”1
The workload in most teaching hospitals is increasing
due to a shift of public-funded patients away from the
private sector. Teaching hospitals are financially strapped,
and the number of anesthesiology residents has decreased
considerably. Academic faculty are required to spend
most of their time providing service in the operating
room while their salaries are being cut due to discriminatory
Medicare reimbursement policies. Faculty are being recruited
to jobs in the private sector, further reducing the
academic workforce and feeding a vicious downward spiral.
Similarly, residents who may have potential for a career
in academia are opting for jobs in the private sector
because they have few academic mentors with whom to
identify, and they have accumulated excessive educational
debts. The number of young American anesthesiologists
performing meaningful research is falling. Research
and development in anesthesiology has dropped, there
are fewer competitive applications for NIH and Foundation
for Anesthesia Education and Research grants, and publications
by U.S. authors in Anesthesiology are in the
minority. Coincidentally, an informal survey of leading
researchers in anesthesiology concluded that interest
in research presentations at the ASA Annual Meeting
is remarkably low.2
The concern of many leaders in American anesthesiology
is that if we continue down this “slippery slope,”
the specialty will be transformed back from a truly
medical discipline, with active research and innovation
by physicians, to one of a strictly clinical service
often provided by nonphysicians. If medical students
and other physicians do not perceive that anesthesiology
is an exciting medical discipline with visible role
models of academic anesthesiologists who continue to
make landmark advances in the field, the medical specialty
of anesthesiology is at risk for demise.
Consequently, it is essential that everything possible
be done to shore up and support our academic bases.
Research and development in anesthesiology must continue
to be recognized as a desirable, even mandatory, goal
of the future. We must make the recruitment and retention
of the “best and the brightest” of medical
students a priority. We must ensure that academic faculty
be properly recognized and financially compensated for
their efforts. Successful academic faculty must be trained
to mentor their successors. Finally, we must ensure
that adequate funding and support are provided so that
these faculty members have the resources to carry out
their important work. Funding must not only be for grants
but also must include dollars to permit academic anesthesiologists
to “buy” their time out of the operating
room. Having a grant, but not having time to perform
the research, is of no benefit.
There are exciting opportunities for research in anesthesiology
that must be pursued such as in the areas of molecular
biology, receptor-specific drug therapy, genomics and
wireless communication. While issues surrounding reimbursement
and scope of practice are important to ASA, we must
consider the support of research and innovation and
the development of new therapeutic techniques as equally
high priorities. The advancement of knowledge is essential
to our survival.
| References: |
| 1. Tremper KK, Gelman S. Surviving the perfect
storm: Challenges faced by our training programs.
ASA Newsl. 2001; 65(2):22-24. |
| 2. Personal communication. Michael M. Todd,
M.D., Anesthesiology editor. March, 2003.
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