Anesthesiology was born in the United States with the first administration of ether for operative surgery in the 1840s. Whether one attributes the first administration of ether to Crawford W. Long on March 30, 1842, or William T.G. Morton on October 16, 1846, the extraordinary discovery of pain-free operations opened the doors to an astonishing growth in surgery as a primary modality for the treatment of a multitude of diseases. It was nearly 100 years later on February 16, 1941, however, that the American Board of Medical Specialties fully recognized the specialty of anesthesiology as a primary board.

For the next 50 years, physician anesthesiology continued to grow at a dramatic rate until the downturn of the early 1990s. At that time, projections for an oversupply of anesthesiologists and threats of decreased reimbursement led to a reduction in those seeking anesthesiology education and training from a high in 1992 of 1,904 first-year anesthesiology trainees to a low in 1996 of 1,073. American medical school graduate interest in the specialty reflected this decreased enthusiasm for an anesthesiology career with 1,609 American graduate first-year trainees in 1992 down to 496 in 1996.

Since then the earlier pessimistic forecasts proved to have been markedly exaggerated, and the specialty has seen a rapid increase in interest among medical graduates to 1,466 first-year trainees in 2001, with 980 of those from American medical schools. Academic programs have been the hardest hit segment of the anesthesiology community as a result of the 1990s reduction in anesthesiology trainees. A workforce needs-assessment by the Society of Academic Anesthesiology Chairs showed that in August 2000, a deficit of nearly 500 faculty full-time equivalents existed in the 132 anesthesiology programs.

Research activities by anesthesiologists have significantly contributed to improved patient care as exemplified by the development of blood-gas analysis (Severinghaus), neonatal assessment (Apgar), anesthetic potency (Eger), labor analgesia (Shnider and Bonica), neuromuscular blockade (Miller and Savarese), pulse oximetry (New) and anesthetic toxicity (Cohen), to name just a few. The current environment, however, has become far less friendly to this most vital component of anesthesiology progress. Furthermore the perception that anesthesia is as safe as can be expected could potentially reduce the perceived need for further research.

A recent study published in the December 2002 issue of Anesthesiology, however, demonstrates that while there has been improvement in safety over the past 50 years, analysis of data revealed mortality rates to still be around 1:13,000 anesthetics. There is much work to do. Increasing demands for clinical productivity, coupled with decreasing reimbursement for clinical anesthesia services, has limited the time available for anesthesiology research. Anesthesiology departments are left with few remaining resources for the pursuit of new knowledge and the investment in those whose accomplishments would help our specialty to grow. If the incentive for academic pursuits is a desire to teach and to contribute to the science of medicine, then escalating demands for clinical service and diminished revenue from clinical efforts (the traditional source of support for faculty time devoted to research and teaching) bodes ill for the continued growth, if not the very survival of, anesthesiology as a scientifically based medical specialty.

Examination of 2002 National Institutes of Health (NIH) funding data is not encouraging in terms of anesthesiology research activity furthering the acquisition of new knowledge. The table on page 37 shows the relative comparisons of NIH awards to medical schools for several types of departments.

Of even greater importance is the fact that only 55 of the 133 (41 percent) anesthesiology programs approved by the Accreditation Council for Graduate Medical Education in 2002 received any NIH awards, of which greater than 40 percent had two or fewer.

Research support for proven, experienced investigators in anesthesiology is readily available as evidenced by examination of current NIH budget proposals. The mission of NIH — “to expand fundamental knowledge about the nature and behavior of living systems and to improve and develop new strategies for the diagnosis, treatment and prevention of disease and communicate the results of research with the goal to improving health” — is closely related to that of FAER, “to promote the generation of new knowledge in anesthesiology that advances patient care and to foster career development of anesthesiologists dedicated to research and education in perioperative, critical care and pain medicine.”

Vital questions still exist that require vigorous investigation, including specific organ monitoring and protection, defining the mechanisms of anesthesia, development of improved anesthetic agents and innovations in pain therapy and palliative care. The NIH budget has increased 15.5 percent annually for the past several years with a budget proposal of $27 billion for 2003 of which $2,356,805,000 is designated for new grants. NIH is only one of a multitude of potential sources of research support. As available as this funding may appear, it is accessible only to applicants who have demonstrated strong potential for meaningful scientific accomplishment, including solid training and experience, a supportive research environment and the availability of a substantial amount of time devoted exclusively to the proposed research project.

Investment in the education of future scientists and educators is essential if anesthesiology is to continue to increase the ability to safely accomplish complex surgical management of diseases. Prior to advancements in anesthesia perioperative care, many disease processes had limited or no options for treatment. Additionally anesthesiologists’ contributions to critical care medicine and pain management have led to vast improvements in patient survival and quality of life. These specialties also require innovation and new knowledge to continue to improve our capability to understand the mechanisms of disease and derive new and improved therapeutic options. With the increasing awareness of opportunities in anesthesiology, our top medical graduates are again opting for postgraduate training in this specialty. The opportunity for expanding the acquisition of new knowledge exists, and the realization that knowledge comes from people is the driving force behind the efforts of FAER.

The role of FAER must be to provide the means to encourage our trainees and young faculty to seek careers in research and education and to allow our programs to provide the time and resources for the development of these individuals into independent investigators who can successfully compete for research and training grants. Established by ASA in 1986, FAER has concentrated its efforts in supporting the mission of ASA as expressed in its strategic plan from 1998, “to support and conduct research to foster optimal patient care and advancement of the specialty.” Up to the present time, FAER has focused its efforts on the awarding of grants to individual anesthesiologists from academic programs on the basis of a rigorous evaluation of specific research proposals. The principles that guide FAER’s operations recognize that the future of anesthesiology depends on the generation of new knowledge. To accomplish that task, fundamental requirements include identifying, growing and educating future investigators and teachers.

The principles that define FAER’s operations include:

• The future of anesthesiology depends on the generation of new knowledge.

• The ability to discover, grow and educate new scientists and educators is fundemental.

• Quality mentoring is essential.

• Creating an educational environment to foster inquiry is the key to the generation of new knowledge.

• Grant proposals are subjected to a rigorous review process by the ASA Committee on Research utilizing objective criteria mutually agreeable to the committee and FAER.

• Awarding of grants is widely recognized for fairness, integrity and excellence.

Myer H. Rosenthal, M.D., is Professor of Anesthesiology, Medicine and Surgery, Stanford University School of Medicine, Stanford, California.