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August 2003
Volume 67 |
Number 8 |
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Our Priorities, Our Research, Our Future
A Residency Review Committee (RRC) representative visited
our residency program last February, and it was with
some trepidation that I opened the envelope that arrived
in May. As with so many things, the news was both good
and less-than-good. We received a continued full accreditation
status, but the RRC expressed concern about several
areas. Number one on their list was a “lack of
investigative activity.”
The next item of mail that I opened was the May issue
of Anesthesiology. As I perused the journal,
I noticed an odd circumstance. There were 10 major articles
in the clinical investigations section. All 10 institutions
of origin were outside of the United States (France
had three, Germany had two, and there was one each from
Japan, Taiwan, Austria, Spain and Australia).
The May issue might have been an aberration, but in
2002, 53 percent of Anesthesiology’s
published investigative articles (not including case
reports, letters, etc.) were from outside the United
States. There has been a steady change in the ratio
of articles from the United States compared to the rest
of the world. There could be a variety of explanations
such as increased investigative activity elsewhere or
American anesthesiologists submitting their work to
other journals. My gut feeling, however, is that there
is less anesthesiology research in the United States
and that the trend is going in the wrong direction.
Perhaps this “lack of investigative activity”
is a national problem, not just a problem in our department.
Why does the RRC make such a big deal about research?
Does this lack of research impact the specialty? Is
this lack of research important to me as a clinical
anesthesiologist? Why do I care what effect endothelium-derived
hyperpolarizing factor has on phenylephrine-induced
oscillatory vasomotion in the rat small mesenteric artery?
I care because I have been fortunate enough to hang
around some of the really smart people in our specialty.
They have convinced me that I may not care much about
the rat’s small mesenteric artery, but I better
care greatly about this research trend in the United
States. They have convinced me that if the trend is
not reversed, organized anesthesiology will become a
trade union representing the financial and political
interests of its craftsman members. Organized anesthesiology
will no longer be an educational and research body searching
for new knowledge to improve patient care and to stimulate
our minds. A specialty grows only as its scientific
basis grows!
Why has this happened? A superficial (but partially
valid) reason is the often-chronicled decrease in resident
applicants, decreased numbers of new anesthesiologists
and subsequent increased clinical and financial production
pressure on academic departments. I do not think that
this is the whole answer, but I do not know the rest
of the answer, either.
What is organized anesthesiology doing to define and
solve the problem?
The 2002 House of Delegates approved a standing Committee
on Academic Anesthesiology, and the Committee on Bylaws
is working on language to accomplish this. There will
be a proposal before the 2003 House to approve a seat
in the Board of Directors for an academic anesthesiology
representative. This new seat represents the culmination
of a series of efforts to strengthen the bond between
academic anesthesiology and ASA.
ASA has committed much lobbying effort to improve reimbursement
to academic departments. The recent letter sent to Centers
for Medicare & Medicaid Services Administrator Thomas
Scully by ASA President James E. Cottrell, M.D., is
an excellent description of the problem (see:
<www.ASAhq.org/aapd-saac/cottrellscully.pdf>).
If successful, this lobbying effort would relieve some
of the financial pressures on our departments.
Dr. Cottrell also has arranged for a session to discuss
anesthesiology research at the August 2003 Board of
Directors meeting. Hopefully, this meeting will prompt
discussion of the issue by the political leaders of
the Society.
The Foundation for Anesthesia Education and Research
has invited a wide variety of our specialty’s
leaders to a retreat on the second weekend in August.
The purpose of the retreat is to “discuss and
evaluate proposals to assist in expanding the productivity
of academic programs, the ability to recruit faculty
and finally to initiate implementation of proposals
to ensure the future of our specialty.” Hopefully,
the retreat will generate ideas that can be transformed
into progress.
These steps are not the complete answer, but we are
moving in the right direction. ASA has a long list of
problems, and we have to be sure of our priorities.
The declining trend in research is the most
significant long-term problem that anesthesiology faces.
It is very important that all of us appreciate the fundamental
importance of research to the specialty, and we need
to rank this at the top of our list of priorities.
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The views expressed herein are those of the authors and
do not necessarily represent or reflect the views, policies
or actions of the American Society of Anesthesiologists.
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