AUA: Teaching the Art and Science of Anesthesiology

The mission of the Association of University Anesthesiologists (AUA) is to advance the art and science of anesthesiology by: 1) encouraging its members to pursue original investigations in the clinic and in the laboratory; 2) developing the method of teaching (anesthesia); and 3) creating a setting for a free and informal interchange of ideas. The details of the genesis of the organization were presented very well during the 50th anniversary meeting of the AUA in Milwaukee, Wisconsin, in May 2003. A report on the founding of the Association was shared through a manuscript prepared by one of the AUA founders, the late Emanuel M. “Manny” Papper, M.D., Ph.D. (1915-2002)

There is an early reference (Ecclesiastes 1:9) to the concept that “there is nothing new under the sun,” and when reflecting on the development of AUA and the challenges facing academic anesthesiology today, the concept rings true. Dr. Papper noted that a primary force in creating AUA was the tension between ASA and salary reimbursement methodology for some academic anesthesiologists. In the formative years of AUA (the early 1950s), many in organized anesthesiology suggested that the only ethical method of salary support for academic anesthesiologists was a fee-for-service model. This appears to have been driven primarily by the resistance within ASA to hospitals “owning” an anesthesiology practice and, by extension, its physicians through the use of salaried payment. In the early 1950s, Dr. Papper and other AUA founders believed the fee-for-service model did not allow the academic physician the flexibility needed to spend the time required to advance research and education.

Now fast-forward with me to 2004 and the challenges faced by academic anesthesiology. Is there a material difference in the lack of flexibility between the early 1950s and today? I posit that though academic anesthesiology has a much larger number of institutions carrying out physician training today, the academic depth of these institutions may not be significantly different from the early 1950s. How can that be?

The challenges academic anesthesiologists face today are the same challenges that existed during the early 1950s, with the dominant portion of most academic anesthesiology departments’ revenue coming from modified fee-for-service work. The wider academic medicine mantra of “mission-based budgeting” has tied time to the dollar in ways that limit growing and nurturing young academic physicians’ careers. The challenges our specialty faced in the 1990s, coupled with the enlarging debt load of medical student graduates, leave a remarkably small number of our residency graduates seriously interested in an academic career. Thus our specialty is facing a serious generational gap in the number of well-grounded, research-trained physicians available to guide the development of new knowledge. All these observations come from someone who considers an academic physician’s job as the best possible one in this world. As an academic anesthesiologist, I have the opportunity to train bright, talented physicians with challenging patients while being stimulated to advance knowledge and keep up with the explosion of medical information. What could be better?

Nevertheless the challenges facing academic anesthesiology have prompted ASA to develop a new Committee on Academic Anesthesiology that is charged with: 1) maintaining a liaison between academic anesthesiology and the Society; 2) representing the interest of academic anesthesiology to the Society; 3) studying and making recommendations pertaining to present and future challenges to academic anesthesiology and to the specialty in general; 4) interacting with other committees to ensure that issues confronting academic anesthesiology are resolved in a strategic fashion; and 5) carrying out other activities relative to academic anesthesiology as may be requested. When this new ASA committee’s charge is considered together with the ongoing work by the Foundation for Anesthesia Education and Research (FAER) in developing ideas on how to more effectively support academic anesthesiology, the case seems clear that the larger specialty senses that academic anesthesiology is in danger.

The danger comes in the form of a limited number of young physicians ages 30 to 45 who are truly building solid academic careers. This is not just a challenge for academic anesthesia — rather, 10 to 15 years from now, it will impact our private practice colleagues when the loss of intellectual curiosity and the potential for dramatically decreased growth in new knowledge within the specialty discourages the best and brightest of our medical students from entering the field.

I offer that the original purpose of AUA is as important today as it was when founded in the 1950s. We need our entire specialty focused on shining very needed spotlights on our academic mission; it remains foundational for future success for all of us.

David L. Brown, M.D., is Professor and Head, Department of Anesthesiology, University of Iowa Health Care, Iowa City, Iowa.